Wu J, Buchsbaum M S, Gillin J C, Tang C, Cadwell S, Wiegand M, Najafi A, Klein E, Hazen K, Bunney W E, Fallon J H, Keator D
Department of Psychiatry and Human Behavior, College of Medicine, University of California, Irvine 92717, USA.
Am J Psychiatry. 1999 Aug;156(8):1149-58. doi: 10.1176/ajp.156.8.1149.
Sleep deprivation has been shown to have an antidepressant benefit in a subgroup of depressed patients. Functional imaging studies by the authors and others have suggested that patients with elevated metabolic rates in the anterior cingulate gyrus at baseline are more likely to respond to either sleep deprivation or antidepressant medications than patients with normal metabolic rates. The authors extend their earlier work in a larger group of patients and explore additional brain areas with statistical probability mapping.
Thirty-six patients with unipolar depression and 26 normal volunteers were studied with positron emission tomography before and after sleep deprivation. Response to sleep deprivation was defined as a 40% or larger decrease in total scores on the Hamilton Depression Rating Scale.
One-third of the depressed patients had a significant response to sleep deprivation. Responders had higher relative metabolic rates in the medial prefrontal cortex, ventral anterior cingulate, and posterior subcallosal gyrus at baseline than depressed patients who did not respond to sleep deprivation and normal volunteers. Lower Hamilton depression scores correlated significantly with lower metabolic rates in the left medial prefrontal cortex. After sleep deprivation, significant decreases in metabolic rates occurred in the medial prefrontal cortex and frontal pole in the patients who responded positively to sleep deprivation.
High pretreatment metabolic rates and decreases in metabolic rates after treatment in the medial prefrontal cortex may characterize a subgroup of depressed patients who improve following sleep deprivation and, perhaps, other antidepressant treatments.
睡眠剥夺已被证明对一部分抑郁症患者具有抗抑郁作用。作者及其他研究人员的功能影像学研究表明，与代谢率正常的患者相比，基线时前扣带回代谢率升高的患者对睡眠剥夺或抗抑郁药物更有可能产生反应。作者在更大规模的患者群体中扩展了他们早期的研究工作，并通过统计概率图谱探索了其他脑区。
对36例单相抑郁症患者和26名正常志愿者在睡眠剥夺前后进行正电子发射断层扫描研究。对睡眠剥夺的反应定义为汉密尔顿抑郁量表总分下降40%或更多。
三分之一的抑郁症患者对睡眠剥夺有显著反应。与未对睡眠剥夺产生反应的抑郁症患者及正常志愿者相比，有反应者在基线时内侧前额叶皮质、腹侧前扣带回和胼胝体下回后部的相对代谢率更高。较低的汉密尔顿抑郁评分与左侧内侧前额叶皮质较低的代谢率显著相关。睡眠剥夺后，对睡眠剥夺产生阳性反应的患者内侧前额叶皮质和额极的代谢率显著下降。
内侧前额叶皮质治疗前高代谢率以及治疗后代谢率下降可能是一部分抑郁症患者的特征，这些患者在睡眠剥夺及或许其他抗抑郁治疗后病情改善。
