Zhu Xi, Helpman Liat, Papini Santiago, Schneier Franklin, Markowitz John C, Van Meter Page E, Lindquist Martin A, Wager Tor D, Neria Yuval
Department of Psychiatry, Columbia University, New York, NY, USA.
New York State Psychiatric Institute, New York, NY, USA.
Depress Anxiety. 2017 Jul;34(7):641-650. doi: 10.1002/da.22594. Epub 2016 Dec 28.
Individuals with comorbid posttraumatic stress disorder and major depressive disorder (PTSD-MDD) often exhibit greater functional impairment and poorer treatment response than individuals with PTSD alone. Research has not determined whether PTSD-MDD is associated with different network connectivity abnormalities than PTSD alone.
We used functional magnetic resonance imaging (fMRI) to measure resting state functional connectivity (rs-FC) patterns of brain regions involved in fear and reward processing in three groups: patients with PTSD-alone (n = 27), PTSD-MDD (n = 21), and trauma-exposed healthy controls (TEHCs, n = 34). Based on previous research, seeds included basolateral amygdala (BLA), centromedial amygdala (CMA), and nucleus accumbens (NAcc).
Regardless of MDD comorbidity, PTSD was associated with decreased connectivity of BLA-orbitalfrontal cortex (OFC) and CMA-thalamus pathways, key to fear processing, and fear expression, respectively. PTSD-MDD, compared to PTSD-alone and TEHC, was associated with decreased connectivity across multiple amygdala and striatal-subcortical pathways: BLA-OFC, NAcc-thalamus, and NAcc-hippocampus. Further, while both the BLA-OFC and the NAcc-thalamus pathways were correlated with MDD symptoms, PTSD symptoms correlated with the amygdala pathways (BLA-OFC; CMA-thalamus) only.
Comorbid PTSD-MDD may be associated with multifaceted functional connectivity alterations in both fear and reward systems. Clinical implications are discussed.
患有创伤后应激障碍和重度抑郁症共病（PTSD-MDD）的个体，往往比仅患有创伤后应激障碍的个体表现出更大的功能损害和更差的治疗反应。研究尚未确定PTSD-MDD是否与仅患有创伤后应激障碍时不同的网络连接异常有关。
我们使用功能磁共振成像（fMRI）来测量三组中参与恐惧和奖赏处理的脑区的静息态功能连接（rs-FC）模式：仅患有创伤后应激障碍的患者（n = 27）、PTSD-MDD患者（n = 21）和有创伤暴露史的健康对照者（TEHCs，n = 34）。基于先前的研究，种子区域包括基底外侧杏仁核（BLA）、中央内侧杏仁核（CMA）和伏隔核（NAcc）。
无论是否合并重度抑郁症，创伤后应激障碍都与恐惧处理的关键通路BLA-眶额皮质（OFC）以及恐惧表达的关键通路CMA-丘脑的连接性降低有关。与仅患有创伤后应激障碍的患者和TEHC相比，PTSD-MDD与多个杏仁核和纹状体-皮质下通路的连接性降低有关：BLA-OFC、NAcc-丘脑和NAcc-海马。此外，虽然BLA-OFC和NAcc-丘脑通路都与重度抑郁症症状相关，但创伤后应激障碍症状仅与杏仁核通路（BLA-OFC；CMA-丘脑）相关。
共病的PTSD-MDD可能与恐惧和奖赏系统中多方面的功能连接改变有关。讨论了其临床意义。
