Young Juan Joseph, Silber Tim, Bruno Davide, Galatzer-Levy Isaac Robert, Pomara Nunzio, Marmar Charles Raymond
Nathan Kline Institute, Orangeburg, NY, USA; Case Western Reserve University, Cleveland, OH, USA; MetroHealth Medical Center, Cleveland, OH, USA.
Nathan Kline Institute , Orangeburg, NY , USA.
Front Psychiatry. 2016 Apr 25;7:72. doi: 10.3389/fpsyt.2016.00072. eCollection 2016.
Major depressive disorder (MDD) contributes to a significant worldwide disease burden, expected to be second only to heart disease by 2050. However, accurate diagnosis has been a historical weakness in clinical psychiatry. As a result, there is a demand for diagnostic modalities with greater objectivity that could improve on current psychiatric practice that relies mainly on self-reporting of symptoms and clinical interviews. Over the past two decades, literature on a growing number of putative biomarkers for MDD increasingly suggests that MDD patients have significantly different biological profiles compared to healthy controls. However, difficulty in elucidating their exact relationships within depression pathology renders individual markers inconsistent diagnostic tools. Consequently, further biomarker research could potentially improve our understanding of MDD pathophysiology as well as aid in interpreting response to treatment, narrow differential diagnoses, and help refine current MDD criteria. Representative of this, multiplex assays using multiple sources of biomarkers are reported to be more accurate options in comparison to individual markers that exhibit lower specificity and sensitivity, and are more prone to confounding factors. In the future, more sophisticated multiplex assays may hold promise for use in screening and diagnosing depression and determining clinical severity as an advance over relying solely on current subjective diagnostic criteria. A pervasive limitation in existing research is heterogeneity inherent in MDD studies, which impacts the validity of biomarker data. Additionally, small sample sizes of most studies limit statistical power. Yet, as the RDoC project evolves to decrease these limitations, and stronger studies with more generalizable data are developed, significant advances in the next decade are expected to yield important information in the development of MDD biomarkers for use in clinical settings.
重度抑郁症（MDD）在全球造成了巨大的疾病负担，预计到2050年将仅次于心脏病。然而，准确诊断一直是临床精神病学的一个历史弱点。因此，人们需要更具客观性的诊断方法，以改进目前主要依赖症状自我报告和临床访谈的精神病学实践。在过去二十年中，关于越来越多MDD假定生物标志物的文献越来越多地表明，与健康对照相比，MDD患者具有显著不同的生物学特征。然而，难以阐明它们在抑郁症病理中的确切关系，使得单个标志物成为不一致的诊断工具。因此，进一步的生物标志物研究可能会增进我们对MDD病理生理学的理解，并有助于解释治疗反应、缩小鉴别诊断范围以及完善当前的MDD标准。与此相关的是，与表现出较低特异性和敏感性且更容易受到混杂因素影响的单个标志物相比，使用多种生物标志物来源的多重检测据报道是更准确的选择。未来，更复杂的多重检测可能有望用于抑郁症的筛查和诊断以及确定临床严重程度，这是对仅依赖当前主观诊断标准的一种进步。现有研究中一个普遍存在的局限性是MDD研究中固有的异质性，这影响了生物标志物数据的有效性。此外，大多数研究的样本量较小，限制了统计效力。然而，随着研究领域标准与分类学整合计划（RDoC）项目的发展以减少这些局限性，以及开展更强大、数据更具普遍性的研究，预计未来十年的重大进展将在开发用于临床环境的MDD生物标志物方面产生重要信息。
