Rothe N, Steffen J, Penz M, Kirschbaum C, Walther A
Biopsychology, Technische Universität Dresden, Dresden, Germany.
Biopsychology, Technische Universität Dresden, Dresden, Germany; University Hospital Dresden, Clinic and Polyclinic for Psychotherapy and Psychosomatics, Dresden, Germany.
Neurosci Biobehav Rev. 2020 Jul;114:232-270. doi: 10.1016/j.neubiorev.2020.02.024. Epub 2020 Feb 20.
It is debated as to whether major depressive disorder (MDD) and the burnout syndrome represent different aspects of the same syndrome or whether they reflect separate entities. A dysregulation of the hypothalamus-pituitary-adrenal-axis has been related to both conditions separately. Dissecting the pathophysiology of the conditions and describing differences and similarities with regard to stress physiological systems might further clarify whether underlying etiological models of these syndromes differ. A systematic literature search including MDD and the burnout syndrome and peripheral cortisol measures was performed and resulted in 190 studies for inclusion in the qualitative synthesis. For MDD, findings suggest a general state of hypercortisolism and glucocorticoid resistance reflected by increased basal cortisol levels, reduced reactivity to psychosocial stress and a reduced cortisol suppression in pharmacological challenge tests. For the burnout syndrome, two central factors limit further conclusions: i) there is not a sufficient amount of studies examining the burnout syndrome and different cortisol secretion patterns to provide an evidence base, ii) the burnout syndrome is assessed heterogeneously reflecting imprecision of the measured constructs. Large prospective cohort studies examining both conditions in parallel rigorously controlling for confounders are required to further elucidate the differences and similarities of the HPA axis in MDD and the burnout syndrome.
关于重度抑郁症（MDD）和倦怠综合征是代表同一综合征的不同方面，还是反映不同的实体，目前存在争议。下丘脑 - 垂体 - 肾上腺轴的失调已分别与这两种情况相关。剖析这些情况的病理生理学，并描述应激生理系统方面的差异和相似之处，可能会进一步阐明这些综合征的潜在病因模型是否不同。进行了一项系统的文献检索，包括MDD、倦怠综合征和外周皮质醇测量，结果有190项研究纳入定性综合分析。对于MDD，研究结果表明存在一种高皮质醇血症和糖皮质激素抵抗的总体状态，表现为基础皮质醇水平升高、对心理社会应激的反应性降低以及在药理激发试验中皮质醇抑制作用减弱。对于倦怠综合征，有两个核心因素限制了进一步的结论：i）没有足够数量的研究来检验倦怠综合征和不同的皮质醇分泌模式，以提供证据基础；ii）倦怠综合征的评估方式多种多样，反映了所测结构的不精确性。需要进行大规模前瞻性队列研究，同时严格控制混杂因素来检查这两种情况，以进一步阐明MDD和倦怠综合征中下丘脑 - 垂体 - 肾上腺轴的差异和相似之处。
