Branchi Igor, Viglione Aurelia, Vai Benedetta, Cirulli Francesca, Benedetti Francesco, Poggini Silvia
Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy.
Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Neurosci Appl. 2023 Nov 8;3:103923. doi: 10.1016/j.nsa.2023.103923. eCollection 2024.
Immune alterations have been widely implicated in the onset, progression, and treatment of major depressive disorder. However, our comprehension of the intricate link between immune function and psychopathology remains fragmented and limited. Here we propose that the interplay between immune function and neural plasticity is key in the transition from psychopathology to mental wellbeing. In particular, any deviation toward an extreme immune activation or suppression leads to a dysregulation in the molecular machinery underlying neural plasticity. Therefore, pro-inflammatory conditions in depressed patients are associated with impaired plasticity, limiting the potential to recover. Patient's confinement within their pathological state is here referred to as an . The normalization of immune activation reinstates plasticity, thereby restoring the capacity to attain mental wellbeing. Since growing evidence is showing that reinstating plasticity does not lead to an improvement but increases the likelihood of recovery, combining the normalization of immune activity with environmental conditions promoting wellbeing is critical to achieve a beneficial outcome. This theoretical framework allows to reconcile key conceptual discrepancies in immunopsychiatry such as the and the issues. Overall, we propose that tuning the immune system to promote neural plasticity is a promising approach to refine and develop innovative therapeutic strategies for depression, leading to personalized and highly effective treatments.
免疫改变在重度抑郁症的发病、进展和治疗中具有广泛影响。然而，我们对免疫功能与精神病理学之间复杂联系的理解仍然零散且有限。在此，我们提出免疫功能与神经可塑性之间的相互作用是从精神病理学向心理健康转变的关键。特别是，任何向极端免疫激活或抑制的偏差都会导致神经可塑性潜在分子机制的失调。因此，抑郁症患者的促炎状态与可塑性受损相关，限制了恢复的潜力。患者被困于其病理状态在此被称为一种……免疫激活的正常化可恢复可塑性，从而恢复获得心理健康的能力。由于越来越多的证据表明恢复可塑性不会导致病情改善，但会增加康复的可能性，将免疫活动的正常化与促进健康的环境条件相结合对于取得有益结果至关重要。这一理论框架有助于调和免疫精神病学中的关键概念差异，如……和……问题。总体而言，我们提出调节免疫系统以促进神经可塑性是完善和开发抑郁症创新治疗策略的一种有前景的方法，可带来个性化且高效的治疗。
