Heim Christine, Plotsky Paul M, Nemeroff Charles B
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
Neuropsychopharmacology. 2004 Apr;29(4):641-8. doi: 10.1038/sj.npp.1300397.
Almost four decades of intensive research have sought to elucidate the neurobiological bases of depression. Epidemiological studies have revealed that both genetic and environmental factors contribute to the risk for depression. Adverse early-life experiences influence neurobiological systems within genetic limits, leading to the neurobiological and behavioral manifestations of depression. We summarize the burgeoning evidence concerning a pre-eminent role of early adverse experience in the pathogenesis of depression. The available data suggest that (1) early adverse experience contributes to the pathophysiology of depression, (2) there are neurobiologically different subtypes of depression depending on the presence or absence of early adverse experience, likely having confounded previous research on the neurobiology of depression, and (3) early adverse experience likely influences treatment response in depression. Classification of depression based on developmental and neurobiological features will likely considerably improve future research in the field of depression, and might lead to optimized treatment strategies that directly target different neurobiological pathways to depression.
近四十年来，大量深入研究致力于阐明抑郁症的神经生物学基础。流行病学研究表明，遗传因素和环境因素均会增加患抑郁症的风险。早期不良经历在遗传限度内影响神经生物学系统，进而导致抑郁症的神经生物学和行为表现。我们总结了有关早期不良经历在抑郁症发病机制中起重要作用的新证据。现有数据表明：（1）早期不良经历会导致抑郁症的病理生理变化；（2）根据是否存在早期不良经历，抑郁症在神经生物学上存在不同亚型，这可能使先前关于抑郁症神经生物学的研究产生混淆；（3）早期不良经历可能影响抑郁症的治疗反应。基于发育和神经生物学特征对抑郁症进行分类，可能会极大地推动该领域未来的研究，并可能带来直接针对不同抑郁症神经生物学途径的优化治疗策略。
