Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany.
Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany.
Eur Arch Psychiatry Clin Neurosci. 2021 Apr;271(3):557-565. doi: 10.1007/s00406-020-01123-0. Epub 2020 Apr 11.
An altered processing of negative salient stimuli has been suggested to play a central role in the pathophysiology of major depression (MD). Besides negative affective and social stimuli, physical pain as a subtype of negative sensory stimulation has been investigated in this context. However, the few neuroimaging studies on unpleasant sensory stimulation or pain processing in MD report heterogeneous findings. Here, we investigated 47 young females, 22 with MD and 25 healthy controls (HC) using fMRI (3.0 T). Four levels of increasingly unpleasant electrical stimulation were applied. Ratings of stimulus intensity were assessed by a visual analogue scale. fMRI-data were analyzed using a 2 × 4 ANOVA. Behavioral results revealed no group differences regarding accuracy of unpleasant stimulation level ratings and sensitivity to stimulation. Regarding neural activation related to increasing levels of unpleasant stimulation, we observed increasing activation of brain regions related to the pain and salient stimulus processing corresponding to increasingly unpleasant stimulation in controls. This modulation was significantly smaller in MD compared to controls, particularly in the dorsal anterior cingulate cortex, the somatosensory cortex, and the posterior insula. Overall, brain regions associated with the processing of unpleasant sensory stimulation, but also associated with the salience network, were highly reactive but less modulated in female patients with MD. These results support and extent findings on altered processing of salience and of negative sensory stimuli even of a non-painful quality in female patients with MD.
负面显著刺激的处理改变被认为在重度抑郁症（MD）的病理生理学中起着核心作用。除了负面情感和社会刺激外，身体疼痛作为一种负面感觉刺激的亚型，在这种情况下也得到了研究。然而，关于 MD 中不愉快感觉刺激或疼痛处理的少数神经影像学研究报告了结果不一致。在这里，我们使用 fMRI（3.0T）对 47 名年轻女性进行了研究，其中 22 名患有 MD，25 名健康对照（HC）。施加了四个逐渐不愉快的电刺激水平。通过视觉模拟量表评估刺激强度的评分。使用 2×4 ANOVA 分析 fMRI 数据。行为结果显示，在不愉快刺激水平评分的准确性和对刺激的敏感性方面，两组之间没有差异。关于与增加不愉快刺激水平相关的神经激活，我们观察到对照组中与疼痛和显著刺激处理相关的大脑区域的激活随着刺激的增加而增加。与对照组相比，MD 中的这种调节明显较小，特别是在前扣带皮层的背侧、躯体感觉皮层和后岛叶。总的来说，与不愉快感觉刺激处理相关的大脑区域，以及与突显网络相关的大脑区域，在患有 MD 的女性患者中反应强烈，但调节较少。这些结果支持并扩展了关于 MD 患者中突显和负面感觉刺激处理改变的发现，甚至包括非疼痛质量的刺激。
