Post Robert M
George Washington University School of Medicine, Washington, DC, USA; Bipolar Collaborative Network, Bethesda, Maryland, USA.
Dialogues Clin Neurosci. 2015 Jun;17(2):105-9. doi: 10.31887/DCNS.2015.17.2/rpost.
Viewing recurrent depression as a potentially progressive illness may help transform treatment toward earlier, more consistent intervention and prevention. Evidence indicates that recurrent stressors, episodes of depression, and bouts of substance abuse can each show sensitization (increased reactivity upon repetition) and cross-sensitization to the others, and drive illness progression and treatment resistance. These long-lasting increases in pathological responsivity appear to be mediated by epigenetic mechanisms involving alterations in chemical marks placed on DNA and histories. These types of sensitization effects are amenable to clinical attempts at amelioration and prevention, and provide treatment targets and strategies to minimize the likelihood of illness progression to treatment resistance.
将复发性抑郁症视为一种潜在的进行性疾病，可能有助于将治疗转向更早、更持续的干预和预防。有证据表明，反复出现的应激源、抑郁发作和药物滥用发作都可能表现出致敏作用（重复时反应性增加）以及对其他因素的交叉致敏作用，并推动疾病进展和治疗抵抗。这些病理反应性的长期增加似乎是由表观遗传机制介导的，这些机制涉及DNA上化学标记和历史的改变。这类致敏作用适合临床进行改善和预防尝试，并提供治疗靶点和策略，以尽量降低疾病进展为治疗抵抗的可能性。
