MIRECC, Cpl. Michael J. Crescenz VA Medical Center, Philadelphia; Perelman School of Medicine of the University of Pennsylvania.
Perelman School of Medicine of the University of Pennsylvania.
Behav Ther. 2020 Jul;51(4):572-587. doi: 10.1016/j.beth.2019.12.005. Epub 2020 Jan 13.
Major depressive disorder with comorbid sleep disturbance has been associated with negative outcomes, including lower rates of treatment response and a greater likelihood of depressive relapse compared to those without sleep disturbance. However, little, if any, research has been conducted to understand why such negative treatment outcomes occur when sleep disturbance is present. In this conceptual review, we argue that the relationship of sleep disturbance and negative treatment outcomes may be mediated by alterations in neural reward processing in individuals with blunted trait-level reward responsivity. We first briefly characterize sleep disturbance in depression, discuss the nature of reward processing impairments in depression, and summarize the sleep/reward relationship in healthy human subjects. We then introduce a novel Integrated Sleep and Reward model of the course and maintenance of major depressive disorder and present preliminary evidence of sleep and reward interaction in unipolar depression. Finally, we discuss limitations of the model and offer testable hypotheses and directions for future research.
伴发睡眠障碍的重性抑郁障碍与负面结局相关，包括治疗反应率较低，与无睡眠障碍者相比，抑郁复发的可能性更高。然而，几乎没有研究旨在理解为什么在存在睡眠障碍时会出现这种负面治疗结果。在本概念性综述中，我们认为睡眠障碍和负面治疗结果之间的关系可能通过个体特质水平奖赏反应性迟钝时神经奖赏加工的改变来介导。我们首先简要描述抑郁中的睡眠障碍，讨论抑郁中的奖赏加工损害的本质，并总结健康人类被试中的睡眠/奖赏关系。然后，我们引入重性抑郁障碍的病程和维持的综合睡眠和奖赏模型，并呈现单相抑郁中睡眠和奖赏相互作用的初步证据。最后，我们讨论了该模型的局限性，并提供了可检验的假说和未来研究方向。
