Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Peking University the Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Health Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
J Clin Psychiatry. 2020 Feb 18;81(2):19m12790. doi: 10.4088/JCP.19m12790.
Reward deficits and associated striatal circuitry have been implicated in the onset and progression of major depressive disorder (MDD). This work was conducted to clarify how the striatal circuitry is involved in the established risk, acute episodes, and remission of MDD.
Striatal subregion resting-state functional connectivity (RSFC) was calculated for 29 currently depressed and 28 remitted patients diagnosed with MDD per the Structured Clinical Interview for DSM-IV, 19 first-degree relatives of these patients, and 57 healthy controls (HCs) based on resting-state fMRI data collected between May 2007 and September 2014.
Compared with HCs, the other 3 groups showed increased RSFC between left dorsal caudate (DC) and right insula but reduced RSFC between right putamen and left cerebellum. The currently depressed group showed increased FC between right DC and superior frontal gyrus but reduced RSFC between putamen and right anterior cingulate as well as other striatal nuclei compared with the other 3 groups. Although no results were found in ventral striatum (VS) seeds during analysis of covariance, the comparison between currently depressed and remitted patients showed increased RSFC between right superior VS and left inferior frontal gyrus in currently depressed patients at a more linear threshold. Also, both superior and inferior VS showed increased RSFC with superior and inferior frontal gyri but reduced RSFC with cerebellum in relatives compared with HCs. Higher DC-superior frontal gyrus RSFC (r = 0.438, P = .022) was correlated with more severe depression, but lower within-putamen FC was correlated with more severe depression (r = -0.446, P = .02) and retardation (r = -0.465, P = .011).
The findings suggest that reduced VS-frontal, within-putamen, and putamen-cingulate RSFC in currently depressed patients is dependent on current depressive episode and has implications for symptomatic monitoring, while increased caudate-insular and reduced VS-cerebellar RSFC in remitted patients and first-degree relatives might be related to the disease itself and have potential for predicting risk for and recurrence of MDD.
奖励缺陷和相关的纹状体回路与重度抑郁症（MDD）的发病和进展有关。这项工作旨在阐明纹状体回路如何参与 MDD 的既定风险、急性发作和缓解。
根据 2007 年 5 月至 2014 年 9 月采集的静息态 fMRI 数据，对 29 名目前患有 MDD 的患者和 28 名缓解期患者（根据 DSM-IV 结构化临床访谈诊断）、这些患者的 19 名一级亲属以及 57 名健康对照者（HCs）的纹状体亚区静息态功能连接性（RSFC）进行了计算。
与 HCs 相比，其他 3 组患者左背侧尾状核（DC）与右岛叶之间的 RSFC 增加，而右壳核与左小脑之间的 RSFC 减少。与其他 3 组相比，目前患有 MDD 的患者右侧 DC 与额上回之间的 FC 增加，而壳核与前扣带回之间以及其他纹状体核之间的 RSFC 减少。虽然在协方差分析中没有在腹侧纹状体（VS）种子中发现结果，但在目前患有 MDD 患者和缓解期患者的比较中，在更线性的阈值下，目前患有 MDD 的患者右侧 Superior VS 与左侧额下回之间的 RSFC 增加。此外，与 HCs 相比，亲属的 Superior 和 Inferior VS 与 Superior 和 Inferior 额回的 FC 增加，与小脑的 FC 减少。DC-额上回 RSFC 较高（r = 0.438，P =.022）与抑郁症状较严重相关，而壳核内 FC 较低（r = -0.446，P =.02）和延迟（r = -0.465，P =.011）与抑郁症状较严重相关。
研究结果表明，目前患有 MDD 的患者 VS-额、壳核内和壳核-扣带回的 RSFC 降低，这取决于当前的抑郁发作，对症状监测具有重要意义，而缓解期患者和一级亲属的尾状核-岛叶和 VS-小脑的 RSFC 增加可能与疾病本身有关，对 MDD 的风险预测和复发具有潜在意义。
