Department of Psychiatry, University of Münster, Münster, Germany.
Department of Clinical Radiology, University of Münster, Münster, Germany.
Neuropsychopharmacology. 2018 Feb;43(3):546-554. doi: 10.1038/npp.2017.246. Epub 2017 Oct 17.
Adolescent-onset major depressive disorder (MDD) is associated with an increased risk of recurrent depressive episodes, suicidal behaviors, and psychiatric morbidity throughout the lifespan. The objective of the present study was to investigate brain structural and functional changes in adolescent patients with MDD. Furthermore, we aimed to clarify the influence of early-life stress on brain function and structure. The study investigated adolescent patients with severe MDD (n=20, mean age=16.0, range=15-18 years) and a control sample of matched healthy adolescents (n=21, mean age=16.6, range=15-18 years). Functional MRI data were obtained using a face-matching paradigm to investigate emotion processing. Structural MRI data were analyzed using voxel-based morphometry (VBM). In line with previous studies on adult MDD, adolescent patients showed elevated amygdala activity to negative and reduced amygdala activity to positive emotional stimuli. Furthermore, MDD patients showed smaller hippocampal volumes compared to healthy adolescents. Higher levels of childhood maltreatment were associated with smaller hippocampal volumes in both depressed patients and healthy controls, whereby no associations between amygdala reactivity and childhood maltreatment were found. Our results suggest that hippocampal alterations in youth MDD patients may at least partly be traced back to higher occurrence of early-life adverse experiences. Regarding the strong morphometric impact of childhood maltreatment and its distinctly elevated prevalence in MDD populations, this study provides an alternative explanation for frequently observed limbic structural abnormalities in depressed patients.
青少年起病的重度抑郁症（MDD）与整个生命周期中复发性抑郁发作、自杀行为和精神疾病发病率增加有关。本研究的目的是探讨青少年 MDD 患者的大脑结构和功能变化。此外，我们旨在阐明早期生活应激对大脑功能和结构的影响。该研究调查了 20 名患有严重 MDD 的青少年患者（平均年龄 16.0 岁，范围 15-18 岁）和 21 名匹配的健康青少年对照组（平均年龄 16.6 岁，范围 15-18 岁）。使用面孔匹配范式获得功能磁共振成像数据以研究情绪处理。使用基于体素的形态测量学（VBM）分析结构磁共振成像数据。与成人 MDD 的先前研究一致，青少年患者在处理负性情绪刺激时杏仁核活动增加，而在处理正性情绪刺激时杏仁核活动减少。此外，MDD 患者的海马体体积比健康青少年小。童年期虐待程度较高与抑郁患者和健康对照组的海马体体积较小有关，但未发现杏仁核反应性与童年期虐待之间存在关联。我们的研究结果表明，青少年 MDD 患者的海马体改变可能至少部分归因于早期生活中不良经历的发生率较高。鉴于童年期虐待对形态学的强烈影响及其在 MDD 人群中明显升高的发生率，本研究为抑郁患者中经常观察到的边缘结构异常提供了另一种解释。
