Wang Xiang, Öngür Dost, Auerbach Randy P, Yao Shuqiao
From the Medical Psychological Institute of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China (Drs. Wang and Yao); Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA (Drs. Öngür and Auerbach).
Harv Rev Psychiatry. 2016 May-Jun;24(3):188-201. doi: 10.1097/HRP.0000000000000081.
Although it is generally accepted that cognitive factors contribute to the pathogenesis of major depressive disorder (MDD), there are missing links between behavioral and biological models of depression. Nevertheless, research employing neuroimaging technologies has elucidated some of the neurobiological mechanisms related to cognitive-vulnerability factors, especially from a whole-brain, dynamic perspective. In this review, we integrate well-established cognitive-vulnerability factors for MDD and corresponding neural mechanisms in intrinsic networks using a dual-process framework. We propose that the dynamic alteration and imbalance among the intrinsic networks, both in the resting-state and the rest-task transition stages, contribute to the development of cognitive vulnerability and MDD. Specifically, we propose that abnormally increased resting-state default mode network (DMN) activity and connectivity (mainly in anterior DMN regions) contribute to the development of cognitive vulnerability. Furthermore, when subjects confront negative stimuli in the period of rest-to-task transition, the following three kinds of aberrant network interactions have been identified as facilitators of vulnerability and dysphoric mood, each through a different cognitive mechanism: DMN dominance over the central executive network (CEN), an impaired salience network-mediated switching between the DMN and CEN, and ineffective CEN modulation of the DMN. This focus on interrelated networks and brain-activity changes between rest and task states provides a neural-system perspective for future research on cognitive vulnerability and resilience, and may potentially guide the development of new intervention strategies for MDD.
尽管人们普遍认为认知因素在重度抑郁症(MDD)的发病机制中起作用,但抑郁的行为模型和生物学模型之间仍存在缺失环节。然而,采用神经成像技术的研究已经阐明了一些与认知易损性因素相关的神经生物学机制,特别是从全脑、动态的角度。在这篇综述中,我们使用双过程框架整合了已确立的MDD认知易损性因素以及内在网络中的相应神经机制。我们提出,内在网络在静息状态和静息-任务转换阶段的动态改变和失衡,促成了认知易损性和MDD的发展。具体而言,我们提出静息状态下默认模式网络(DMN)活动和连接性异常增加(主要在DMN前部区域)促成了认知易损性的发展。此外,当受试者在从静息到任务转换期间面对负面刺激时,已确定以下三种异常网络相互作用是易损性和烦躁情绪的促成因素,每种相互作用都通过不同的认知机制:DMN对中央执行网络(CEN)的主导、突显网络介导的DMN和CEN之间切换受损,以及CEN对DMN的无效调节。这种对相互关联网络以及静息和任务状态之间大脑活动变化的关注,为未来关于认知易损性和恢复力的研究提供了神经系统视角,并可能潜在地指导MDD新干预策略的开发。