Department of Psychiatry and Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
Curr Psychiatry Rep. 2012 Dec;14(6):634-42. doi: 10.1007/s11920-012-0322-7.
Major depressive disorder is a serious medical illness which is responsible for considerable morbidity and disability. Despite decades of research, the neural basis for depression is still incompletely understood. In this review, evidence from neuroimaging, neuropsychiatric and brain stimulations studies are explored to answer the question regarding the localization of depression in the brain. Neuroimaging studies indicate that although many regions of the brain have been repeatedly implicated in the pathophysiology of depression, not many consistent findings have been found until present. In recent times, the focus of neuroimaging has shifted from regional brain abnormalities to circuit level connectivity abnormalities. However, connectivity models are inherently more complicated, and the validity of these models remains to be tested. Neuropsychiatric studies of illnesses such as Parkinson's disease and stroke provide promising clues regarding areas involved in depression, but again consistent findings are rare. Similarly, stimulation of a variety of brain regions and circuits has been reported as being effective in depression. Therefore, the current knowledge indicates that the pathophysiology of depression may be distributed across many brain regions and circuits. In future studies, this distributed nature of depression needs to be further investigated, primary and secondary areas affected need to be identified, and new paradigms to explain complex mental functions need to be explored.
重度抑郁症是一种严重的医学疾病，会导致相当大的发病率和残疾。尽管经过几十年的研究，抑郁症的神经基础仍不完全清楚。在这篇综述中，探讨了神经影像学、神经精神病学和脑刺激研究的证据，以回答关于大脑中抑郁症定位的问题。神经影像学研究表明，尽管大脑的许多区域都被反复牵涉到抑郁症的病理生理学中，但直到现在还没有发现多少一致的发现。最近，神经影像学的重点已经从区域大脑异常转移到回路水平的连接异常。然而，连接模型本质上更加复杂，这些模型的有效性仍有待检验。帕金森病和中风等神经精神病学研究为涉及抑郁症的区域提供了有希望的线索，但一致的发现仍然很少。同样，刺激各种大脑区域和回路已被报道对抑郁症有效。因此，目前的知识表明，抑郁症的病理生理学可能分布在许多大脑区域和回路中。在未来的研究中，需要进一步研究抑郁症的这种分布性质，确定受影响的主要和次要区域，并探索解释复杂心理功能的新范式。
