Xu Xin, Zhou Qian, Wen Fei, Yang Mingzhe
Department of Psychology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Depress Anxiety. 2024 May 15;2024:6633510. doi: 10.1155/2024/6633510. eCollection 2024.
Although patients with major depressive disorder (MDD) achieve remission after antidepressant treatment, >90% of those in remission have at least one residual depressive symptom, which may be due to neural damage linked with MDD. To better understand the structural impairments in patients with remitted MDD, we conducted a meta-analysis comparing grey matter volume (GMV) abnormalities between patients with remitted MDD and healthy controls (HCs). There were 11 cross-sectional datasets that investigated 275 patients with remitted MDD versus 437 HCs, and 7 longitudinal datasets that investigated 167 patients with remitted MDD. We found that GMV in the left insula, inferior parietal gyri, amygdala, and right superior parietal gyrus was decreased in patients with remitted MDD than in HCs. Additionally, patients with remitted MDD had lower GMV in the bilateral gyrus rectus than those in the nonremission state. Moreover, increased GMV in the bilateral anterior cingulate cortex, right striatum, middle temporal gyrus, and superior frontal gyrus was observed in patients with remitted MDD than in HCs. Furthermore, patients with remitted MDD had a larger GMV in the bilateral median cingulate/paracingulate gyri, left striatum, putamen, amygdala, hippocampus, and parahippocampal gyrus at follow-up than at baseline. Based on the brain morphological abnormalities in patients with remitted MDD after electroconvulsive therapy and pharmacological treatment, we proposed a schematic diagram of targeted intervention approaches for residual symptoms. In summary, our findings provide neurobiology-based evidence for multitarget treatment of depression to reduce residual symptoms and improve social function in patients with MDD.
尽管重度抑郁症（MDD）患者在接受抗抑郁治疗后实现了缓解，但缓解的患者中>90%至少有一个残留抑郁症状，这可能是由于与MDD相关的神经损伤所致。为了更好地了解缓解期MDD患者的结构损伤，我们进行了一项荟萃分析，比较缓解期MDD患者与健康对照（HCs）之间的灰质体积（GMV）异常情况。有11个横断面数据集研究了275例缓解期MDD患者与437例HCs，以及7个纵向数据集研究了167例缓解期MDD患者。我们发现，缓解期MDD患者左侧脑岛、顶下小叶、杏仁核和右侧顶上小叶的GMV低于HCs。此外，缓解期MDD患者双侧直回的GMV低于未缓解状态的患者。而且，与HCs相比，缓解期MDD患者双侧前扣带回皮质、右侧纹状体、颞中回和额上回的GMV增加。此外，缓解期MDD患者随访时双侧中央旁扣带回/扣带旁回、左侧纹状体、壳核、杏仁核、海马和海马旁回的GMV大于基线时。基于电休克治疗和药物治疗后缓解期MDD患者的脑形态学异常，我们提出了针对残留症状的靶向干预方法示意图。总之，我们的研究结果为抑郁症的多靶点治疗提供了基于神经生物学的证据，以减少残留症状并改善MDD患者的社会功能。
