Zierotin Anna, Mondelli Valeria, Zajkowska Zuzanna
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK.
Neurosci Appl. 2024 Jul 2;3:104082. doi: 10.1016/j.nsa.2024.104082. eCollection 2024.
Studies in adults have identified potential biomarkers for therapeutic response in depression; however, less is known in the context of depression in young people. Understanding predictive biomarkers could improve treatment selection, considering the low treatment response rates in adolescents and young adults with depression. This study aimed to investigate the relationship between cortisol, immune, and neural markers and treatment outcomes of psychotherapy or antidepressant treatment in young people with depression. We searched OVID Medline, EMBASE, Global Health, and PsycINFO for peer-reviewed studies investigating cortisol, immune and neuroimaging markers in adolescents diagnosed with MDD, ages 10-24, undergoing psychotherapy or antidepressant treatment. Of 25 included studies, 15 assessed neural markers, 8 assessed immune markers, 1 assessed cortisol markers, and 1 assessed neural and cortisol markers. Elevated cortisol response to stress was associated with greater symptom improvement following psychotherapy or antidepressant treatment. Findings regarding the impact of SSRIs on Interleukin (IL)- 1 beta, IL-4, IL-6 and tumour necrosis factor-alpha (TNF-α) are inconsistent, suggesting a potential inflammatory subtype but also highlighting the need for further research. Increased activation and connectivity in brain regions involved in emotion regulation and decreased connectivity of the default mode network were associated with better treatment outcomes after psychotherapy and antidepressant treatment. Our results suggest that neural and immune markers might be involved in the treatment mechanisms through which depression improves. We identified several potential biomarkers associated with treatment outcomes; however, the heterogeneity among study designs and biomarker measurements was high. Future research should investigate biomarkers of differential treatment response, replicate existing studies and focus on predictive analyses of treatment outcomes.
针对成年人的研究已确定了抑郁症治疗反应的潜在生物标志物；然而，对于年轻人抑郁症的情况了解较少。鉴于青少年和青年抑郁症患者的治疗反应率较低，了解预测性生物标志物有助于改善治疗选择。本研究旨在探讨皮质醇、免疫和神经标志物与抑郁症青年患者心理治疗或抗抑郁治疗结果之间的关系。我们在OVID Medline、EMBASE、Global Health和PsycINFO中检索了同行评审研究，这些研究调查了年龄在10 - 24岁、被诊断为重度抑郁症且正在接受心理治疗或抗抑郁治疗的青少年的皮质醇、免疫和神经影像标志物。在纳入的25项研究中，15项评估了神经标志物，8项评估了免疫标志物，1项评估了皮质醇标志物，1项评估了神经和皮质醇标志物。应激时皮质醇反应升高与心理治疗或抗抑郁治疗后症状改善更大有关。关于选择性5-羟色胺再摄取抑制剂（SSRI）对白细胞介素（IL）-1β、IL-4、IL-6和肿瘤坏死因子-α（TNF-α）影响的研究结果不一致，这表明可能存在一种潜在的炎症亚型，但也凸显了进一步研究的必要性。参与情绪调节的脑区激活增加和连接性增强以及默认模式网络连接性降低与心理治疗和抗抑郁治疗后的更好治疗结果相关。我们的结果表明，神经和免疫标志物可能参与了抑郁症改善的治疗机制。我们确定了几种与治疗结果相关的潜在生物标志物；然而，研究设计和生物标志物测量之间的异质性很高。未来的研究应调查不同治疗反应的生物标志物，重复现有研究并专注于治疗结果的预测分析。
