Raison Charles L, Miller Andrew H
Department of Psychiatry, College of Medicine, John and Doris Norton School of Family and Consumer Sciences, University of Arizona, Tucson, Ariz., USA.
Mod Trends Pharmacopsychiatry. 2013;28:33-48. doi: 10.1159/000343966. Epub 2013 Feb 27.
Like all psychiatric conditions, depression is a complex phenomenon that is unlikely to yield to simple monolithic explanatory paradigms. Nonetheless, increasing evidence suggests that the immune system in general and inflammatory processes in particular, may contribute to depressive pathogenesis in a significant proportion of otherwise medically healthy individuals struggling with the disorder. In this chapter, we review the best current evidence suggesting that inflammatory processes contribute to the development of depression, both via direct actions on the brain as well as by effects on secondary pathways that marry brain to body. We review epidemiological evidence linking inflammation to depression before reviewing findings that exposure to inflammatory stimuli produce depressive symptoms in concert with brain-body changes known to be common in depression. Following this review of the role of inflammation in depressive causation, we consider emerging evidence that immunomodulatory interventions may hold promise as antidepressants, especially in individuals with elevations in peripheral inflammatory biomarkers. Interventions discussed include cytokine and cyclo-oxygenase antagonists, as well as agents that impact inflammatory transcription factors/signaling cascades. We conclude with a brief discussion of the potential role of various behavioral strategies in reducing inflammation and thereby enhancing emotional well-being.
与所有精神疾病一样，抑郁症是一种复杂的现象，不太可能用简单单一的解释范式来阐释。然而，越来越多的证据表明，一般的免疫系统，尤其是炎症过程，可能在相当一部分原本身体健康但患有该疾病的个体的抑郁发病机制中起作用。在本章中，我们回顾了目前最有力的证据，这些证据表明炎症过程通过对大脑的直接作用以及对连接大脑与身体的次级途径的影响，促成了抑郁症的发展。在回顾暴露于炎症刺激会与抑郁症中常见的脑-体变化一起产生抑郁症状的研究结果之前，我们先回顾将炎症与抑郁症联系起来的流行病学证据。在回顾了炎症在抑郁病因中的作用之后，我们考虑新出现的证据，即免疫调节干预可能有望成为抗抑郁药，特别是在外周炎症生物标志物升高的个体中。讨论的干预措施包括细胞因子和环氧化酶拮抗剂，以及影响炎症转录因子/信号级联反应的药物。我们最后简要讨论了各种行为策略在减轻炎症从而增强情绪健康方面的潜在作用。
