重性抑郁障碍的正性和负性情绪系统具有不同的临床特征、对抗抑郁药的反应及与免疫标志物的关系。
Positive and negative valence systems in major depression have distinct clinical features, response to antidepressants, and relationships with immunomarkers.
机构信息
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.
Academic Medicine Research Institute and Office Clinical Sciences, Duke-National University of Singapore, Singapore.
出版信息
Depress Anxiety. 2020 Aug;37(8):771-783. doi: 10.1002/da.23006. Epub 2020 Mar 18.
BACKGROUND
Heterogeneity in major depressive disorder (MDD) is well recognized but not well understood. Core depressive features are reward and emotional symptoms, which reflect dysfunctions in the positive valence (PV) and negative valence (NV) systems, respectively. This study assessed whether PV and NV systems (based on selected symptoms) were associated with different clinical features, antidepressant response, and levels of immunomarkers in adults with MDD.
METHODS
These analyses used data from combining medications to enhance depression outcomes study (N = 665; n = 166 for immunomarkers). PV and NV symptom scores were extracted from the clinician-rated 30-item Inventory of Depressive Symptomatology. Correlational analyses were conducted.
RESULTS
PV and NV symptom scores were substantially associated with different clinical features. PV symptoms (impaired motivation, impaired energy, and anhedonia) were independently associated with female gender (p < .001), older age (p = .012), and higher cognitive and physical impairment (p < .001) according to the 7-item Cognitive and Physical Functioning Questionnaire. Conversely, NV symptoms (anxiety and interpersonal sensitivity) were independently associated with younger age (p = .013), more anxious comorbidities (p = .001 for generalized anxiety disorder and p = .002 for social phobia) and other commonly associated noncriterion symptoms (p < .001). Overall, PV symptoms were more responsive to antidepressants than NV symptoms (p < .0001; Cohen's d = .455). A PV symptom score was positively correlated with the concentration of three proinflammatory and one anti-inflammatory factor. In contrast, an NV symptom score was negatively associated with only one proinflammatory immunomarker.
CONCLUSIONS
PV and NV system functions appear to be reflected in selected clinical symptoms that differentially relate to other clinical features, treatment outcomes, and immunological function.
背景
重度抑郁症（MDD）的异质性是公认的，但尚未得到充分理解。核心抑郁症状是奖赏和情绪症状，分别反映正性价（PV）和负性价（NV）系统的功能障碍。本研究评估了 PV 和 NV 系统（基于选定的症状）是否与不同的临床特征、抗抑郁反应以及 MDD 成年患者的免疫标志物水平相关。
方法
这些分析使用了结合药物增强抑郁治疗结果研究的数据（N=665；n=166 用于免疫标志物）。PV 和 NV 症状评分从临床医生评定的 30 项抑郁症状清单中提取。进行了相关分析。
结果
PV 和 NV 症状评分与不同的临床特征密切相关。PV 症状（动机受损、能量受损和快感缺失）与女性性别（p<0.001）、年龄较大（p=0.012）和认知及身体功能障碍较高（p<0.001）独立相关，根据 7 项认知和身体功能问卷。相反，NV 症状（焦虑和人际敏感）与年龄较小（p=0.013）、更严重的焦虑共病（广泛性焦虑障碍 p=0.001 和社交恐惧症 p=0.002）和其他常见相关的非标准症状（p<0.001）独立相关。总体而言，PV 症状对抗抑郁药物的反应优于 NV 症状（p<0.0001；Cohen's d=0.455）。PV 症状评分与三种促炎和一种抗炎因子的浓度呈正相关。相比之下，NV 症状评分仅与一种促炎免疫标志物呈负相关。
结论
PV 和 NV 系统功能似乎反映在与其他临床特征、治疗结果和免疫功能相关的选定临床症状中。
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