Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.
Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.
J Affect Disord. 2019 May 1;250:249-259. doi: 10.1016/j.jad.2019.03.015. Epub 2019 Mar 5.
Major depressive disorder (MDD) is a complex and heterogeneous disorder in which clinical symptoms can widely differ among patients. Neurovegetative symptoms, i.e. decreased or increased appetite, changes in body weight and sleep disturbances, described as 'melancholic' or 'atypical' features of a depressive episode, are the most variable symptoms among patients with MDD. We hypothesized biomarkers differences underlying this neurovegetative variability in major depression.
We systematically reviewed, according to the PRISMA guidelines, the role of specific metabolic, hormonal and inflammatory biomarkers in drug-free MDD patients, that could have neurobiological effects on appetite, weight regulation and circadian rhythms, influencing eating behaviour and sleep patterns. All studies regarding the co-occurrence of disturbed sleep and appetite were examined.
Besides the well-known leptin and ghrelin, other biomarkers such as BDNF, VEGF, NPY, orexin, and the recent discovered nesfatin-1 seem to be involved in neurovegetative changes in depressive disorders playing a role in the regulation of affective states, stress reactions and sleep patterns. Interestingly, based on the existing evidence, ghrelin, orexin and nesfatin-1 could be linked both to sleep and appetite regulation in depressed patients.
Heterogeneous studies with low sample size.
Despite the wide heterogeneity of results, studies on biomarkers of appetite and sleep in MDD are an interesting field of research to explain the neurobiological substrates of depressive symptoms that deserve further investigation.
重度抑郁症（MDD）是一种复杂且异质的疾病，其临床症状在患者之间存在广泛差异。神经植物性症状，即食欲减退或增加、体重变化和睡眠障碍，被描述为抑郁发作的“忧郁”或“非典型”特征，是 MDD 患者最具变异性的症状。我们假设这种神经植物性变异性的基础是生物标志物的差异。
我们根据 PRISMA 指南系统地回顾了无药物治疗的 MDD 患者中特定代谢、激素和炎症生物标志物的作用，这些标志物可能对食欲、体重调节和昼夜节律产生神经生物学影响，从而影响进食行为和睡眠模式。所有关于睡眠和食欲紊乱共病的研究都进行了检查。
除了众所周知的瘦素和胃饥饿素外，其他生物标志物，如 BDNF、VEGF、NPY、食欲素和最近发现的 nesfatin-1，似乎也参与了抑郁障碍的神经植物性变化，在调节情绪状态、应激反应和睡眠模式方面发挥作用。有趣的是，根据现有证据，ghrelin、orexin 和 nesfatin-1 可能与抑郁患者的睡眠和食欲调节都有关联。
研究样本量小，异质性大。
尽管结果存在广泛的异质性，但 MDD 患者的食欲和睡眠生物标志物研究是一个有趣的研究领域，可以解释抑郁症状的神经生物学基础，值得进一步研究。
