CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China.
Center for Cognitive Science of Language, Beijing Language and Culture University, Beijing, China.
Hum Brain Mapp. 2021 Jun 1;42(8):2593-2605. doi: 10.1002/hbm.25391. Epub 2021 Feb 27.
Previous neuroimaging studies have revealed abnormal functional connectivity of brain networks in patients with major depressive disorder (MDD), but findings have been inconsistent. A recent big-data study found abnormal intrinsic functional connectivity within the default mode network in patients with recurrent MDD but not in first-episode drug-naïve patients with MDD. This study also provided evidence for reduced default mode network functional connectivity in medicated MDD patients, raising the question of whether previously observed abnormalities may be attributable to antidepressant effects. The present study (ClinicalTrials.gov identifier: NCT03294525) aimed to disentangle the effects of antidepressant treatment from the pathophysiology of MDD and test the medication normalization hypothesis. Forty-one first-episode drug-naïve MDD patients were administrated antidepressant medication (escitalopram or duloxetine) for 8 weeks, with resting-state functional connectivity compared between posttreatment and baseline. To assess the replicability of the big-data finding, we also conducted a cross-sectional comparison of resting-state functional connectivity between the MDD patients and 92 matched healthy controls. Both Network-Based Statistic analyses and large-scale network analyses revealed intrinsic functional connectivity decreases in extensive brain networks after treatment, indicating considerable antidepressant effects. Neither Network-Based Statistic analyses nor large-scale network analyses detected significant functional connectivity differences between treatment-naïve patients and healthy controls. In short, antidepressant effects are widespread across most brain networks and need to be accounted for when considering functional connectivity abnormalities in MDD.
先前的神经影像学研究表明,重度抑郁症(MDD)患者的大脑网络功能连接存在异常,但研究结果并不一致。最近的一项大数据研究发现,复发性 MDD 患者的默认模式网络内部存在异常的固有功能连接,但在首次发作且未使用药物的 MDD 患者中则没有发现这种现象。该研究还为接受药物治疗的 MDD 患者的默认模式网络功能连接减少提供了证据,这引发了一个问题,即以前观察到的异常是否可能归因于抗抑郁药的作用。本研究(ClinicalTrials.gov 标识符:NCT03294525)旨在将抗抑郁治疗的效果与 MDD 的病理生理学分开,并检验药物正常化假说。41 名首次发作且未使用药物的 MDD 患者接受了 8 周的抗抑郁药物(艾司西酞普兰或度洛西汀)治疗,比较了治疗后和基线时的静息状态功能连接。为了评估大数据研究结果的可重复性,我们还对 MDD 患者和 92 名匹配的健康对照者之间的静息状态功能连接进行了横断面比较。网络基统计分析和大规模网络分析都显示,治疗后广泛的大脑网络中的固有功能连接减少,表明抗抑郁药的效果相当显著。网络基统计分析和大规模网络分析均未检测到治疗初发患者与健康对照组之间的功能连接差异。总之,抗抑郁药的效果广泛存在于大多数大脑网络中,在考虑 MDD 中的功能连接异常时需要将其考虑在内。