Klok Margit Philomène C, van Eijndhoven Philip F, Argyelan Miklos, Schene Aart H, Tendolkar Indira
Psychiatrist, Department of Psychiatry, Radboud University Medical Center, the Netherlands.
Psychiatrist, Department of Psychiatry, Radboud University Medical Center; and Donders Institute for Brain Cognition and Behavior, Centre for Cognitive Neuroimaging, the Netherlands.
BJPsych Open. 2019 Sep 2;5(5):e76. doi: 10.1192/bjo.2019.58.
Major depressive disorder (MDD) has been related to structural brain characteristics that are correlated with the severity of disease. However, the correlation of these structural changes is less well clarified in treatment-resistant depression (TRD).
To summarise the existing literature on structural brain characteristics in TRD to create an overview of known abnormalities of the brain in patients with MDD, to form hypotheses about the absence or existence of a common pathophysiology of MDD and TRD.
A systematic search of PubMed and the Cochrane Library for studies published between 1998 and August of 2016 investigating structural brain changes in patients with TRD compared with healthy controls or patients with MDD.
Fourteen articles are included in this review. Lower grey matter volume (GMV) in the anterior cingulate cortex, right cerebellum, caudate nucleus, superior/medial frontal gyrus and hippocampus does not seem to differentiate TRD from milder forms of MDD. However, lower GMV in the putamen, inferior frontal gyrus, precentral gyrus, angular- and post-central gyri together with specific mainly parietal white matter tract changes seem to be more specific structural characteristics of TRD.
The currently available data on structural brain changes in patients with TRD compared with milder forms of MDD and healthy controls cannot sufficiently distinguish between a 'shared continuum hypothesis' and a 'different entity hypothesis'. Our review clearly suggests that although there is some overlap in affected brain regions between milder forms of MDD and TRD, TRD also comes with specific alterations in mainly the putamen and parietal white matter tracts.
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重度抑郁症（MDD）与大脑结构特征有关，这些特征与疾病严重程度相关。然而，在难治性抑郁症（TRD）中，这些结构变化的相关性尚不清楚。
总结关于TRD大脑结构特征的现有文献，以概述MDD患者已知的大脑异常，形成关于MDD和TRD是否存在共同病理生理学的假设。
系统检索PubMed和Cochrane图书馆，查找1998年至2016年8月发表的研究，这些研究调查了TRD患者与健康对照或MDD患者相比的大脑结构变化。
本综述纳入了14篇文章。前扣带回皮质、右侧小脑、尾状核、额上回/额中回和海马体灰质体积（GMV）降低似乎无法区分TRD与较轻形式的MDD。然而，壳核、额下回、中央前回、角回和中央后回的GMV降低，以及特定的主要顶叶白质束变化似乎是TRD更具特异性的结构特征。
目前关于TRD患者与较轻形式的MDD和健康对照相比大脑结构变化的数据，不足以区分“共享连续体假说”和“不同实体假说”。我们的综述明确表明，虽然较轻形式的MDD和TRD在受影响的脑区存在一些重叠，但TRD还伴有主要在壳核和顶叶白质束的特定改变。
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