van Praag H M
Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands.
Acta Psychiatr Scand Suppl. 1998;393:81-8. doi: 10.1111/j.1600-0447.1998.tb05971.x.
The concept of a serotonin (5-HT)-related, anxiety and/or aggression-driven, stressor-precipitated depression is formulated and discussed. The serotonergic disturbances found in some depressed individuals, particularly those with lowered CSF 5-HIAA, are linked to the anxiety and aggression components of the depressive syndrome. In this type of depression, called 5-HT-related depression, dysregulation of anxiety and/or aggression is hypothesized to be primordial and mood-lowering is a derivative phenomenon. In other words, this is a group of anxiety/aggression-driven depressions. The author submits that the serotonergic impairment in certain types of depression is a trait phenomenon, i.e. it persists during remission. This disturbance makes the individual susceptible to perturbation of anxiety and aggression regulation. Anxiety and (overt or suppressed) anger are core constituents of the stress syndrome. Thus the serotonergic disturbance will induce a heightend sensitivity to stressful events, i.e. the latter will induce stress phenomena, including anxiety and anger, more readily than normal. The latter psychological features induce lowering of mood, and thus 'drive' the patient into a full-blown depression. Furthermore, it is predicted that anxiolytics and serenics (i.e. anti-aggressive drugs) that act via normalization of serotonergic circuits will exert an antidepressant effect in 5-HT related depression, in addition to their therapeutic actions in anxiety disorders and states of increased aggressiveness, respectively. The exact nature of the serotonergic impairment in 5-HT-related depression has yet to be elucidated.
本文提出并讨论了一种与血清素（5-羟色胺，5-HT）相关、由焦虑和/或攻击性驱动、应激源诱发的抑郁症概念。在一些抑郁症患者中发现的血清素能紊乱，尤其是那些脑脊液中5-羟吲哚乙酸（5-HIAA）水平降低的患者，与抑郁综合征的焦虑和攻击成分有关。在这种被称为5-HT相关抑郁症的类型中，焦虑和/或攻击性的失调被认为是原发性的，而情绪低落是一种衍生现象。换句话说，这是一组由焦虑/攻击性驱动的抑郁症。作者认为，某些类型抑郁症中的血清素能损伤是一种特质现象，即在缓解期仍会持续存在。这种紊乱使个体容易受到焦虑和攻击调节的干扰。焦虑和（明显的或被抑制的）愤怒是应激综合征的核心组成部分。因此，血清素能紊乱会导致对压力事件的敏感性增加，即压力事件比正常情况更容易诱发包括焦虑和愤怒在内的应激现象。后者这些心理特征会导致情绪低落，从而将患者“推向”全面发作的抑郁症。此外，据预测，通过使血清素能回路正常化而起作用的抗焦虑药和抗攻击性药物（即抗攻击药物），除了分别在焦虑症和攻击性增强状态中发挥治疗作用外，还将在5-HT相关抑郁症中发挥抗抑郁作用。5-HT相关抑郁症中血清素能损伤的确切性质尚待阐明。
