Toldo Neurobehavioral Institute, Windsor Regional Hospital, Windsor, ON, Canada; Schulich School of Medicine, Western University, London, ON, Canada.
Faculty of Medicine, McGill University; McGill University Health Centre, McGill University, Montreal, QC, Canada.
Psychiatry Res. 2014 Dec;220 Suppl 1:S34-44. doi: 10.1016/S0165-1781(14)70004-6.
Major depressive disorder (MDD) is a common disorder with a lifetime prevalence of 16.2% and the fourth highest cause of disability globally. It is hypothesized to be a syndromatic manifestation of multiple pathological processes leading to similar clinical manifestation. MDD is associated with at least three categories of peripheral hormone-type factors including neurotrophic factors, proinflammatory cytokines, and processes that impair regulation of the hypothalamic-pituitary-adrenocortical axis. Neuroimaging studies have identified functional abnormalities including subcortical systems associated with reward and emotion processing, medial prefrontal and anterior cingulate cortical regions and the lateral prefrontal cortical systems involved in cognitive control and voluntary emotion regulation. Studies investigating the effects of psychotherapy and pharmacotherapy on functional brain measures show normalization of brain function with return to euthymia. Nevertheless, approximately 50% of patients with MDD will not respond sufficiently and 60 to 70% will not achieve full remission with first-line pharmacotherapy, therefore clinicians strive to improve patient responses through the use of adjunct therapies. This review discusses recent research in the various biological processes associated with MDD as well as recent data in support of the use of adjunctive non-pharmacological therapies including psychotherapy, bibliotherapy, Internet therapy, "natural" or herbal approaches, exercise therapy, and somatic therapies.
重性抑郁障碍（MDD）是一种常见疾病，终生患病率为 16.2%，是全球第四大致残原因。它被假设为多种导致相似临床表现的病理过程的综合征表现。MDD 与至少三类外周激素型因素有关，包括神经营养因子、促炎细胞因子以及损害下丘脑-垂体-肾上腺皮质轴调节的过程。神经影像学研究已经确定了功能异常，包括与奖励和情绪处理相关的皮质下系统、内侧前额叶和前扣带皮质区域以及涉及认知控制和自愿情绪调节的外侧前额叶皮质系统。研究心理治疗和药物治疗对功能性大脑测量的影响表明，随着病情好转，大脑功能恢复正常。然而，约 50%的 MDD 患者对治疗反应不足，60%至 70%的患者在一线药物治疗后无法达到完全缓解，因此临床医生努力通过使用辅助治疗来提高患者的反应。这篇综述讨论了与 MDD 相关的各种生物学过程的最新研究，以及支持辅助非药物治疗的最新数据，包括心理治疗、阅读疗法、互联网治疗、“天然”或草药方法、运动疗法和躯体治疗。
