Jiang Jing, Ferraro Stefania, Zhao Youjin, Wu Baolin, Lin Jinping, Chen Taolin, Gao Jin, Li Lei
Department of Radiology, The Affiliated Hospital of Southwest Jiao Tong University, The Third People's Hospital of Chengdu, Chengdu, Sichuan 610036, China.
Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
Psychoradiology. 2024 Nov 4;4:kkae022. doi: 10.1093/psyrad/kkae022. eCollection 2024.
Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are common stress-related psychiatric disorders. Genetic and neurobiology research has supported the viewpoint that PTSD and MDD may possess common and disorder-specific underlying mechanisms. In this systematic review, we summarize evidence for the similarities and differences in brain functional and structural features of MDD, PTSD, and their comorbidity, as well as the effects of extensively used therapies in patients with comorbid PTSD and MDD (PTSD + MDD). These functional magnetic resonance imaging (MRI) studies highlight the (i) shared hypoactivation in the prefrontal cortex during cognitive and emotional processing in MDD and PTSD; (ii) higher activation in fear processing regions including amygdala, hippocampus, and insula in PTSD compared to MDD; and (iii) distinct functional deficits in brain regions involved in fear and reward processing in patients with PTSD + MDD relative to those with PTSD alone. These structural MRI studies suggested that PTSD and MDD share features of reduced volume in focal frontal areas. The treatment effects in patients with PTSD + MDD may correlate with the normalization trend of structural alterations. Neuroimaging predictors of repetitive transcranial magnetic stimulation response in patients with PTSD + MDD may differ from the mono-diagnostic groups. In summary, neuroimaging studies to date have provided limited information about the shared and disorder-specific features in MDD and PTSD. Further research is essential to pave the way for developing improved diagnostic markers and eventually targeted treatment approaches for the shared and distinct brain alterations presented in patients with MDD and PTSD.
创伤后应激障碍（PTSD）和重度抑郁症（MDD）是常见的与应激相关的精神障碍。遗传和神经生物学研究支持了PTSD和MDD可能具有共同的以及特定于疾病的潜在机制这一观点。在本系统综述中，我们总结了关于MDD、PTSD及其共病在脑功能和结构特征方面异同的证据，以及广泛使用的治疗方法对PTSD和MDD共病患者（PTSD + MDD）的影响。这些功能磁共振成像（MRI）研究突出了以下几点：（i）MDD和PTSD在认知和情绪处理过程中前额叶皮质共同存在激活不足；（ii）与MDD相比，PTSD在包括杏仁核、海马体和脑岛在内的恐惧处理区域有更高的激活；（iii）与单纯患有PTSD的患者相比，PTSD + MDD患者在涉及恐惧和奖赏处理的脑区存在明显的功能缺陷。这些结构MRI研究表明，PTSD和MDD在额叶局部区域存在体积减小的共同特征。PTSD + MDD患者的治疗效果可能与结构改变的正常化趋势相关。PTSD + MDD患者重复经颅磁刺激反应的神经影像学预测指标可能与单一诊断组不同。总之，迄今为止的神经影像学研究提供了关于MDD和PTSD中共同特征和特定于疾病特征的有限信息。进一步的研究对于为开发改进的诊断标志物以及最终为MDD和PTSD患者所呈现的共同和独特的脑改变制定针对性治疗方法铺平道路至关重要。
