Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands.
Neurosci Biobehav Rev. 2022 Jan;132:433-448. doi: 10.1016/j.neubiorev.2021.12.008. Epub 2021 Dec 7.
Treatment-resistant depression (TRD) is a debilitating condition associated with higher medical costs, increased illness burden, and reduced quality of life compared to non-treatment-resistant major depressive disorder (MDD). The question arises whether TRD can be considered a distinct MDD sub-type based on neurobiological features. To answer this question we conducted a systematic review of neuroimaging studies investigating the neurobiological differences between TRD and non-TRD. Our main findings are that patients with TRD show 1) reduced functional connectivity (FC) within the default mode network (DMN), 2) reduced FC between components of the DMN and other brain areas, and 3) hyperactivity of DMN regions. In addition, aberrant activity and FC in the occipital lobe may play a role in TRD. The main limitations of most studies were related to inherent confounding factors for comparing TRD with non-TRD, such as differences in disease chronicity/severity and medication history. Future studies may use prospective longitudinal neuroimaging designs to delineate which effects are present in treatment-naive patients and which effects are the result of disease progression.
治疗抵抗性抑郁症（TRD）是一种使人虚弱的疾病，与非治疗抵抗性重度抑郁症（MDD）相比，其医疗费用更高，疾病负担更重，生活质量更低。那么，TRD 是否可以根据神经生物学特征被视为一种独特的 MDD 亚型呢？为了回答这个问题，我们对探讨 TRD 和非 TRD 之间神经生物学差异的神经影像学研究进行了系统综述。我们的主要发现是，TRD 患者表现出 1）默认模式网络（DMN）内的功能连接（FC）减少，2）DMN 成分与其他脑区之间的 FC 减少，以及 3）DMN 区域的过度活跃。此外，枕叶的异常活动和 FC 可能在 TRD 中发挥作用。大多数研究的主要局限性与将 TRD 与非 TRD 进行比较时固有的混杂因素有关，例如疾病的慢性/严重程度和用药史的差异。未来的研究可能会使用前瞻性纵向神经影像学设计来描绘哪些影响存在于未经治疗的患者中，哪些影响是疾病进展的结果。
