From the Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; the Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China; and the Center for Functional Neuroimaging, Department of Neurology, University of Pennsylvania, Philadelphia.
Am J Psychiatry. 2017 Oct 1;174(10):971-979. doi: 10.1176/appi.ajp.2017.16080974. Epub 2017 Jun 16.
Stress is a strong risk factor for major depressive disorder, while sensitization to stress in remitted individuals plays a key role in depression recurrence. The present study explored the state-independent (trait) and dependent (state) neural responses to psychosocial stress in major depressive disorder.
Thirty-six patients with medication-naive first-episode current depression, 33 patients with remitted depression, and 36 demographically matched healthy control participants were administered the Montreal Imaging Stress Task during functional MRI. One-way analyses of variance were used to assess differences in stress responses in the three groups.
Both currently depressed and remitted patients exhibited higher stress levels and cortisol responses than control subjects. Compared with control subjects, both depressed and remitted patients exhibited reduced activation in the ventromedial prefrontal cortex and increased activation in the precuneus. The stress-induced ventromedial prefrontal cortex activation changes negatively correlated with cortisol increases in all three groups. Additional increased activations were found in the dorsolateral prefrontal cortex and bilateral striatum in remitted patients compared with control subjects, and activation in these regions correlated inversely with depressive symptoms in the remitted group.
These findings provide novel evidence regarding the trait and state markers of depression on neural responses to psychosocial stress. Regional activation changes in the ventromedial prefrontal cortex and precuneus may reflect the trait markers of depression. Hyperactivation in the dorsolateral prefrontal cortex and striatum may represent a state-dependent compensatory mechanism during depression remission.
压力是导致重度抑郁症的一个强烈风险因素，而缓解期个体对压力的敏感则在抑郁复发中起着关键作用。本研究旨在探讨重度抑郁症患者在社会心理压力下的状态独立（特质）和依赖（状态）神经反应。
对 36 名未经药物治疗的首发当前抑郁症患者、33 名缓解期抑郁症患者和 36 名年龄匹配的健康对照参与者进行蒙特利尔成像应激任务功能磁共振检查。采用单因素方差分析评估三组应激反应的差异。
目前抑郁和缓解期的患者都表现出比对照组更高的压力水平和皮质醇反应。与对照组相比，抑郁和缓解期的患者都表现出腹内侧前额叶皮层的激活减少和楔前叶的激活增加。应激诱导的腹内侧前额叶皮层激活变化与三组的皮质醇增加呈负相关。与对照组相比，缓解期患者的背外侧前额叶皮层和双侧纹状体的激活增加，而这些区域的激活与缓解期组的抑郁症状呈负相关。
这些发现为社会心理应激下的抑郁神经反应的特质和状态标志物提供了新的证据。腹内侧前额叶皮层和楔前叶的区域激活变化可能反映了抑郁的特质标志物。背外侧前额叶皮层和纹状体的过度激活可能代表了缓解期抑郁的一种状态依赖的补偿机制。
