Ai Hui, Opmeer Esther M, Veltman Dick J, van der Wee Nic J A, van Buchem Mark A, Aleman André, van Tol Marie-José
Department of Neuroscience, Neuroimaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
1] Department of Psychiatry, VU University Medical Center Amsterdam, Amsterdam, The Netherlands [2] Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands.
Neuropsychopharmacology. 2015 Sep;40(10):2454-63. doi: 10.1038/npp.2015.96. Epub 2015 Apr 10.
Major depressive disorder (MDD) is characterized by a heterogeneous course and identifying patients at risk for an unfavorable course is difficult. Neuroimaging studies may identify brain predictors of clinical course and may help to further unravel the neurobiological processes underlying an unfavorable course. We investigated whether brain activation during an emotional memory paradigm is associated with depressive course. To this end, we followed 74 MDD patients and 45 healthy controls (HCs) for 2 years. At baseline, participants performed an emotional word-encoding and -recognition task during functional magnetic resonance imaging. Activation patterns were compared between patients with fast remission (n=22), remission with recurrence (n=23), non-remission (n=29), and HCs. Additionally, linear relations of brain activation and time to remission during the follow-up period were investigated across patients. We observed that during encoding of negative words, non-remitters showed higher activation of the left insula than HCs. Groups also differed in activation of the right hippocampus and left amygdala during negative encoding, with a trend for higher activation in non-remitters compared with HCs. Furthermore, hippocampal activation during negative word encoding was significantly and positively correlated with time to remission, irrespective of illness severity. Our findings suggest that higher activation in the left insula could serve as a neural marker of a naturalistic non-remitting course, whereas higher hippocampal activation is associated with delayed remission. Longitudinal analyses should clarify whether abnormal activation progresses further as a function of time with depression or may serve as load-independent markers of MDD course.
重度抑郁症（MDD）具有异质性病程，识别有不良病程风险的患者很困难。神经影像学研究可能会识别出临床病程的脑预测指标，并可能有助于进一步揭示不良病程背后的神经生物学过程。我们研究了情绪记忆范式期间的脑激活是否与抑郁病程相关。为此，我们对74名MDD患者和45名健康对照者（HCs）进行了为期2年的随访。在基线时，参与者在功能磁共振成像期间执行情绪单词编码和识别任务。比较了快速缓解患者（n = 22）、缓解后复发患者（n = 23）、未缓解患者（n = 29）和HCs之间的激活模式。此外，还研究了随访期间脑激活与缓解时间的线性关系。我们观察到，在对负面单词进行编码时，未缓解者的左脑岛激活程度高于HCs。在负面编码期间，各组在右脑海马体和左杏仁核的激活也存在差异，未缓解者的激活程度与HCs相比有更高的趋势。此外，无论疾病严重程度如何，负面单词编码期间的海马体激活与缓解时间均呈显著正相关。我们的研究结果表明，左脑岛的较高激活可能是自然病程中不缓解的神经标志物，而较高的海马体激活与缓解延迟有关。纵向分析应阐明异常激活是否会随着抑郁症病程的时间进一步发展，或者是否可作为MDD病程的负荷独立标志物。
