Chuang Jie-Yu, J Whitaker Kirstie, Murray Graham K, Elliott Rebecca, Hagan Cindy C, Graham Julia Me, Ooi Cinly, Tait Roger, Holt Rosemary J, van Nieuwenhuizen Adrienne O, Reynolds Shirley, Wilkinson Paul O, Bullmore Edward T, Lennox Belinda R, Sahakian Barbara J, Goodyer Ian, Suckling John
Department of Psychiatry, University of Cambridge.
Department of Psychiatry, University of Cambridge.
J Affect Disord. 2016 Jan 1;189:54-61. doi: 10.1016/j.jad.2015.09.008. Epub 2015 Sep 11.
Depression in adolescence is debilitating with high recurrence in adulthood, yet its pathophysiological mechanism remains enigmatic. To examine the interaction between emotion, cognition and treatment, functional brain responses to sad and happy distractors in an affective go/no-go task were explored before and after Cognitive Behavioural Therapy (CBT) in depressed female adolescents, and healthy participants.
Eighty-two Depressed and 24 healthy female adolescents, aged 12-17 years, performed a functional magnetic resonance imaging (fMRI) affective go/no-go task at baseline. Participants were instructed to withhold their responses upon seeing happy or sad words. Among these participants, 13 patients had CBT over approximately 30 weeks. These participants and 20 matched controls then repeated the task.
At baseline, increased activation in response to happy relative to neutral distractors was observed in the orbitofrontal cortex in depressed patients which was normalised after CBT. No significant group differences were found behaviourally or in brain activation in response to sad distractors. Improvements in symptoms (mean: 9.31, 95% CI: 5.35-13.27) were related at trend-level to activation changes in orbitofrontal cortex.
In the follow-up section, a limited number of post-CBT patients were recruited.
To our knowledge, this is the first fMRI study addressing the effect of CBT in adolescent depression. Although a bias toward negative information is widely accepted as a hallmark of depression, aberrant brain hyperactivity to positive distractors was found and normalised after CBT. Research, assessment and treatment focused on positive stimuli could be a future consideration. Moreover, a pathophysiological mechanism distinct from adult depression may be suggested and awaits further exploration.
青少年抑郁症具有致残性，成年后复发率高，但其病理生理机制仍不清楚。为了研究情绪、认知与治疗之间的相互作用，我们对抑郁女性青少年和健康参与者在认知行为疗法（CBT）前后，在情感性Go/No-Go任务中对悲伤和快乐干扰刺激的脑功能反应进行了探索。
82名年龄在12至17岁之间的抑郁女性青少年和24名健康女性青少年在基线时进行了功能磁共振成像（fMRI）情感性Go/No-Go任务。参与者被要求在看到快乐或悲伤的词语时抑制反应。在这些参与者中，13名患者接受了约30周的CBT治疗。这些参与者和20名匹配的对照组随后重复了该任务。
在基线时，抑郁患者眶额皮质对快乐相对于中性干扰刺激的激活增加，CBT后恢复正常。在行为或对悲伤干扰刺激的脑激活方面未发现显著的组间差异。症状改善（平均值：9.31，95%可信区间：5.35 - 13.27）在趋势水平上与眶额皮质的激活变化有关。
在随访部分，招募的CBT后患者数量有限。
据我们所知，这是第一项研究CBT对青少年抑郁症影响的fMRI研究。尽管对负面信息的偏向被广泛认为是抑郁症的一个标志，但我们发现对积极干扰刺激存在异常的脑过度活跃，且CBT后恢复正常。未来可能需要考虑针对积极刺激的研究、评估和治疗。此外，可能提示存在一种与成人抑郁症不同的病理生理机制，有待进一步探索。
