PPerimenopausal depression （PMD） is a mental disorder that occurs in women before and after menopause. It has become a major public health problem posing a threat to the health of perimenopausal women due to its high incidence， low prevalence， low diagnostic rate， and recurrent episodes. The pathogenesis of PMD is complex and mainly involves the aging of the hypothalamic-pituitary-ovarian （HPO） axis， which leads to abnormal fluctuations in reproductive hormones， inflammation and cascade reactions， and oxidative stress. Currently， there are no specific pharmacological interventions for PMD. Traditional Chinese medicine （TCM）， as a treasure of motherland medicine， integrates thousands of years of TCM experience and wisdom and has the advantages of holistic regulation， low toxicity， and mild adverse reactions in the prevention and treatment of PMD. In recent years， more and more studies have been conducted on the active ingredients， extracts， and compound formulas of TCM for treating PMD via multi-components and multi-directions， achieving fruitful results. A large number of studies have shown that TCM treats PMD by reducing inflammation， inhibiting oxidation， and modulating monoamine neurotransmitter levels， which mainly involve NOD-like receptor thermal protein domain-associated protein 3 （NLRP3） inflammasome， nuclear factor E₂-related factor 2 （Nrf2）/hemeoxygenase-1 （HO-1）， brain-derived neurotrophic factor （BDNF）/tyrosine kinase receptor B （TrkB） and other signaling pathways. This article reviews the clinical and basic studies about TCM treatment of PMD to analyzes the pathogenesis of PMD and the therapeutic targets of TCM， aiming to provide basic theoretical support and new approaches for the TCM treatment of PMD.

Depression, a heterogeneous disorder with symptoms involving emotion, cognition, and behavior, is characterized by high morbidity, low treatment acceptance, and recurrent episodes. It is expected to become a major disease in the global healthcare burden by 2030. The pathogenesis of depression is complex, involving genetic, environmental, neurological, immune, endocrine and other factors, among which neuroplasticity plays a key role in the development of depression and antidepressant treatment. Neuroplasticity can occur in various brain regions and involves a variety of molecular and cellular mechanisms, including neurogenesis, synaptic plasticity, neurotrophic factors, and neuronal apoptosis. Hippocampus is a key brain region for memory and emotional information processing, and its neuroplasticity has become a research hotspot in neuroscience in recent years. Traditional Chinese medicine(TCM) has a long history of preventing and treating depression, with complete basic theories, rich therapeutic experience, and profound therapeutic efficacy. A large number of animal and cellular experiments have shown that TCM can modulate hippocampal neuroplasticity to ameliorate depression, which is another important manifestation of the concept of micro-differentiation in TCM and the modernization of TCM. However, there is a lack of a comprehensive review and summary at present. In view of this problem, this paper systematically reviews the pathological mechanisms of hippocampal neuroplasticity dysregulation in the development of depression and the mechanisms of TCM modulation of hippocampal neuroplasticity in the treatment of depression, with a view to providing new ideas for the in-depth study of TCM in the prevention and treatment of depression.
Neuronal Plasticity/drug effects* ; Hippocampus/physiopathology* ; Humans ; Animals ; Depression/physiopathology* ; Drugs, Chinese Herbal/pharmacology* ; Medicine, Chinese Traditional