van Praag H M
Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands.
Psychiatry Res. 1996 Dec 20;65(3):143-57. doi: 10.1016/s0165-1781(96)02923-x.
The hypothesis is proposed of a new subtype of depression named: stressor-precipitated, cortisol-induced, serotonin-related, anxiety/aggression-driven depression (SeCA depression). Biologically, these patients are characterized by impaired 5-HT synthesis and reduced 5-HT1A receptor sensitivity. Under normal conditions these functions proceed marginally; in times of stress they easily fail, due to sustained overproduction of cortisol. Psychopathologically this depression type shows the following characteristics: anxiety and aggression, not mood lowering, heralding a depressive episode; the personality structure shows 'character neurotic' impairments and tolerance for (certain) traumatic life events is low. As specific therapeutic agents selective 5-HT1A agonists and cortisol or CRH antagonists are proposed. Prophylactically, maintenance treatment with 5-HT1A agonists seems indicated as well as psychological interventions to increase the stressor threshold.
提出了一种新的抑郁症亚型假说，名为：应激源诱发、皮质醇诱导、血清素相关、焦虑/攻击驱动型抑郁症（SeCA抑郁症）。从生物学角度来看，这些患者的特征是5-羟色胺（5-HT）合成受损以及5-HT1A受体敏感性降低。在正常情况下，这些功能仅能勉强维持；在应激状态下，由于皮质醇持续过量分泌，它们很容易失效。从精神病理学角度来看，这种抑郁症类型具有以下特征：焦虑和攻击行为，而非情绪低落，预示着抑郁发作；人格结构显示出“性格神经症”损伤，对（某些）创伤性生活事件的耐受性较低。作为特定治疗药物，建议使用选择性5-HT1A激动剂以及皮质醇或促肾上腺皮质激素释放激素（CRH）拮抗剂。在预防方面，似乎需要使用5-HT1A激动剂进行维持治疗以及采取心理干预措施来提高应激源阈值。
