抑郁症与白介素关系的研究进展

炎症反应与抑郁症的发展密切相关,抑郁症患者常伴有白介素(Interleukin,IL)等促炎细胞因子水平升高,当人体的免疫系统受到外界刺激时会激活产生IL,其中促炎细胞因子浓度增加,可能通过细胞信号传导等途径,导致脑神经营养作用减弱,中枢神经胶质细胞损伤,下丘脑-垂体-肾上腺轴功能亢进,减少中枢单胺类神经递质分泌,而I...     

抑郁症抗炎治疗的研究进展

炎症因子参与抑郁症的发生发展,可有效预测抗抑郁药物治疗的应答情况;抗炎治疗的选择和疗效有赖于患者的炎症活性水平,伴有高炎症活性的抑郁症患者可从抗炎治疗中获益,而低炎症活性患者可能恶化症状。鉴于相关研究的局限性,当前很难将研究结论推广应用于抑郁症的临床诊疗。未来需开展更多高质量的研究进一步明确哪些患者可以从哪种抗炎治疗中获益。     

抗炎治疗在抑郁症中使用的疗效研究

本文目的是探讨抑郁症免疫炎症机制和抗炎治疗对抑郁症的效果。抑郁症是最常见的精神障碍之一,其发病机制目前尚未完全明确,炎症假说是目前公认的发病机制之一。近年来,大量研究表明使用非甾体类抗炎药物治疗抑郁症有一定的效果。本文就抑郁症免疫炎症机制和非甾体类药物抗炎治疗对抑郁症的效果进行综述,为抑郁症的治疗提供新的方向。     

抗抑郁剂联合治疗在抑郁症中的研究进展

抗抑郁剂联合治疗(combined therapy)策略即同时使用两种抗抑郁剂,是临床上经常使用的治疗选择,尤其是随着新一代抗抑郁剂的安全性显著提高.目前,选择性5-羟色胺再摄取抑制剂与不同抗抑郁剂联合使用已被广泛用于对单药治疗无效的患者.同时,为缩短起效时间,提高治愈率,也尝试将联合治疗应用于抑郁症的初始或早期治疗阶...     

甘丙肽在抑郁症病理机制中的研究进展

抑郁症是一种病因不明的、多因素复杂疾病。研究显示,甘丙肽与抑郁症发病关系密切,本文就甘丙肽与抑郁症关系做一综述报告。     

运动治疗抑郁症的炎症机制进展

抑郁症是我国重要的公共卫生问题之一，但其确切的生物学机制尚未完全明了，其中抑郁症的炎症机制越来越受到重视。有研究显示，运动能够预防抑郁症的发作和治疗抑郁症。本文旨在综述运动治疗抑郁症的相关分子炎症和细胞炎症机制研究进展。     

高压氧治疗抑郁症的效果及机制研究进展

目前,高压氧疗法因副作用少且操作方便的特点,可作为治疗抑郁症的潜在方法。本文通过综述高压氧治疗抑郁症的临床应用现状和作用机制,以期为抑郁症治疗新策略的制定提供参考。高压氧疗法现已被作为抑郁症患者的有效疗法,可通过调节下丘脑-垂体-肾上腺轴、抑制神经炎症以及增强突触可塑性,进而改善抑郁症患者的临床症状。高压氧疗法作为抗抑郁药物的联合治疗方法,在一定程度上有助于改善治疗效果。     

中药配方在抑郁症治疗中的研究进展

抑郁症对人体的身心健康造成了极大的伤害,已有的西药抗抑郁剂不能满足所有患者的 需求,中药方剂和成药在抑郁症治疗中的作用引起了学者的广泛关注。现对目前常用的几种中药配方 进行总结归纳,对它们的临床疗效和作用机制进行综述。     

NLRP3炎症小体与抑郁症的相关性研究进展

抑郁症严重影响人们的身心健康,其发病机制涉及神经递质紊乱、内分泌、炎症、氧化应 激等多方面。近几年来,有关抑郁症在炎症免疫系统方面的研究日益增多,NLRP3 炎症小体在免疫系 统功能中起重要的作用。现针对NLRP3 炎症小体在抑郁症发病中的机制作简要综述,为抑郁症的诊断 和治疗提供新的参考。     

抑郁症药物治疗新进展

本论述抑郁症及抗抑郁药方面的新进展，包括单胺及受体的作用，单受受体假说的补充及最瓣药物等。     

部分多模态MRI在重度抑郁症中的研究进展

重度抑郁症是最常见的高致残性的精神疾病之一,其发病机制尚不清楚。MRI技术作为非侵入性的神经影像技术,可揭示重度抑郁症患者大脑功能状态。与健康对照者相比,重度抑郁症患者额叶、颞叶、海马、扣带回、基底节、小脑等脑区功能改变,可能提示重度抑郁症的病理生理异常。现就多模态MRI,包括弥散张量成像(DTI)、弥散峰度成像(DKI)、磁共振波谱成像(MRS)、功能MRI(fMRI)、神经突方向分散度和密度成像(NODDI)在重度抑郁症中的最新研究成果进行综述,以期对其神经生物学机制有更充分的理解。     

A randomized, double-blind study comparing LY2216684 and placebo in the treatment of major depressive disorder

The efficacy, tolerability, and safety of LY2216684, a highly selective norepinephrine reuptake inhibitor, were studied in adult patients with major depressive disorder (MDD). This randomized, double-blind study compared flexible-dose LY2216684 6-18 mg once daily (N = 250) with placebo (N = 245) for 10 weeks acute therapy followed by 1 year LY2216684 treatment (results not reported here). Primary inclusion criteria consisted of GRID 17-item Hamilton Rating Scale for Depression total score ≥18 and Clinical Global Impressions-Severity score ≥4. The primary efficacy measure was the Montgomery-Asberg Depression Rating Scale (MADRS) total score. Response was defined as a ≥50% reduction in MADRS score and remission as MADRS total score ≤10. Global functioning was assessed using the Sheehan Disability Scale (SDS). LY2216684-treated patients showed significant improvement from baseline on the MADRS total score compared with placebo-treated patients (−13.3 vs. −9.8, p < .001), and they had a significantly higher probability of achieving response (49.5%) and remission (29.7%) compared with placebo-treated patients (29.3% and 18.8%, respectively). For the SDS global functional impairment score, LY2216684 treatment resulted in significantly greater improvement compared with placebo treatment (p < .001). More LY2216684-treated than placebo-treated patients discontinued from the study because of an adverse event or death (9.6% vs. 1.6%, p ≤ .001). LY2216684 was associated with significant increases (p < .01) from baseline in systolic (3 mm Hg) and diastolic (4 mm Hg) blood pressure and pulse (10 bpm) compared with placebo. LY2216684 6-18 mg demonstrated significant efficacy and was tolerated in the treatment of MDD.     

Duloxetine for the treatment of major depressive disorder: a closer look at efficacy and safety data across the approved dose range

OBJECTIVE: This analysis focuses on efficacy and safety data obtained from studies of duloxetine for the treatment of major depressive disorder (MDD) within the approved dose range of 40-60 mg/day. METHOD: Efficacy and safety data were obtained from the acute phase portions of four randomized, double-blind, placebo-controlled clinical trials in patients meeting DSM-IV criteria for MDD. In Studies 1 and 2, patients were randomized to duloxetine 60 mg once daily (QD) (n=123 [Study 1]; n=128 [Study 2]) or placebo (n=122 [Study 1]; n=139 [Study 2]) for 9 weeks. In Studies 3 and 4, patients were randomized to duloxetine 20 mg twice daily (BID) (n=91 [Study 3]; n=86 [Study 4]) or placebo (n=90 [Study 3]; n=89 [Study 4]) for 8 weeks. Efficacy measures included the 17-item Hamilton Rating Scale for Depression (HAMD17) total score (primary outcome), HAMD17 subscales, the Clinical Global Impression of Severity (CGI-S) and Patient Global Impression of Improvement (PGI-I) scales, and Visual Analog Scales (VAS) for pain. Safety assessments included rates of discontinuation due to adverse events, spontaneously reported treatment-emergent adverse events, and changes in vital signs. RESULTS: In both studies of duloxetine 60 mg QD, mean change in HAMD17 total score was significantly greater in duloxetine-treated patients compared with placebo (Study 1, p<.001; Study 2, p=.024). At a dose of 20 mg BID, duloxetine demonstrated significant superiority over placebo on the HAMD17 total score in one of the two studies (Study 4, p=.034). Probabilities of remission among patients receiving duloxetine 60 mg QD were 44.2% in Study 1 (p<.001 vs. placebo) and 43.0% in Study 2 (NS), while for patients receiving duloxetine 20 mg BID the probabilities of remission were 27.2% in Study 3 (NS) and 36.1% in Study 4 (NS). Across the six assessed VAS measures of pain severity and interference, the main effect of treatment for duloxetine 60 mg QD was significantly superior to placebo on 7 of the 12 outcomes in Studies 1 and 2, while duloxetine 20 mg BID was not superior to placebo on any of the 12 outcomes in Studies 3 and 4. The rate of discontinuation due to adverse events was 13.1% among patients receiving duloxetine 60 mg QD, and 11.9% at a dose of 20 mg BID. The most frequently reported treatment-emergent adverse events at both doses included nausea, headache, dry mouth, dizziness, and insomnia. The incidence of treatment-emergent nausea among patients receiving duloxetine 60 mg QD was 37.8%, compared with 16.4% among patients receiving 20 mg BID. CONCLUSION: Duloxetine provides safe and effective acute phase treatment of MDD at doses of 40-60 mg/day. Compared with placebo, the 60 mg QD dose was more consistently effective than the 20 mg BID dose. However, the incidence of certain treatment-emergent adverse events is likely to be lower at the 40 mg dose.     

抑郁障碍快感缺失的机制、评估和治疗进展

抑郁障碍是一类常见的精神疾病,主要表现为情绪低落、兴趣减退、精力下降。快感缺失是指人们不能体验到快乐或是对快乐的体验能力不高,对抑郁障碍的诊治具有重大作用和意义。因此,本文综述国内外相关研究,从快感缺失的发生机制、评估方法、治疗手段3个方面展开叙述,希冀为精神卫生工作者提供借鉴和帮助。     

重性抑郁障碍的临床特征及其性别差异

目的了解重性抑郁障碍的临床特征及其性别差异。方法采用多阶段分层整群抽样方法随机抽取18周岁及以上的人群10073名,以改编后的一般健康问卷12项（GHQ-12）为筛选工具,以美国精神障碍诊断与统计手册第四版（DSM-IV）轴I障碍定式临床检查患者版（SCID-I/P）为调查的诊断工具。结果重性抑郁障碍的抑郁心境、失眠、疲倦或精力缺乏、兴趣或愉快感缺乏、思考力降低、体重减轻或食欲下降、无价值感、自己死亡的想法、精神运动性激越的出现频率较高;在抑郁发作类型、季节特征、既往发作缓解程度、目前类型、症状严重程度、首次发作年龄及反复发作间歇期的性别比较均无统计学差异。结论重性抑郁障碍各种临床症状的出现频率不同,性别对重性抑郁障碍临床特征的影响有待进一步研究。     

Predictors of depressive symptoms at hospital discharge in patients with major depressive disorder

Abstract

Objective. Often patients with major depressive disorder (MDD) leave the hospital with continued significant symptomatology. This study sought to evaluate demographic, clinical, and psychosocial predictors of the presence of clinically significant depressive symptoms, defined as a Modified Hamilton Rating Scale for Depression score of ≥ 14, immediately following hospitalization for MDD. Methods. The study enrolled 135 patients with MDD as part of a larger clinical trial investigating the efficacy of post-hospitalization pharmacologic and psychosocial treatments for depressed inpatients. Structured clinical interview and self-report data were available from 126 patients at hospital admission and discharge. Results. Despite the significant decreases in depressive symptoms over the course of hospitalization, 91 (72%) displayed clinically significant depressive symptoms at discharge. Multivariate logistic regression analysis revealed that female sex, earlier age of onset, and poorer social adjustment were unique predictors of symptom outcome. Conclusions. Results suggest that a large proportion of patients leave the hospital with continued significant symptomatology, and the presence of such symptoms following hospitalization for MDD is likely to be explained by a combination of factors.     

Circadian genes in major depressive disorder

Abstract

Background: Sleep disturbances are a common symptom of major depressive disorder (MDD). Sleep is highly regulated by circadian rhythms, controlled by circadian genes, that act through a series of feedback loops to regulate the sleep-wake cycle.

Objectives: To the best of our knowledge, a systematic review regarding the core circadian genes and their role in MDD has not been published recently. Also, a review of these genes and their role in sleep disturbances in depressed individuals appears to have never been done. We decided to integrate both concepts into one comprehensive review.

Method: The review was done using the appropriate search terms in the following search engines: OVID Medline, Embase, PsycINFO and Pubmed.

Results: Based on the data reviewed, none of the circadian genes appear to be associated with MDD, but some are more promising than others. These genes are: CRY1, CRY2, PER2 and NPAS2. When investigating the role of circadian genes in sleep disturbances among individuals with MDD, the most promising candidate gene is TIMELESS. Although the results in this area are limited.

Conclusion: Given the promising leads from this review, future studies should investigate circadian genes in sleep disturbances among the depressed population.     

Duloxetine-induced liver injury in patients with major depressive disorder

Duloxetine is a balanced serotonin-norepinephrine reuptake inhibitor. Duloxetine-induced liver injury in patients with preexisting liver disease or chronic alcohol use is known. However, we have found that duloxetine can also induce liver injury in cases without those risk factors. We recommend that clinicians should monitor liver function carefully following duloxetine treatment.     

Nuclear receptors modulate inflammasomes in the pathophysiology and treatment of major depressive disorder

Major depressive disorder (MDD) is highly prevalent and is a significant cause of mortality and morbidity worldwide. Currently, conventional pharmacological treatments for MDD produce temporary remission in < 50% of patients; therefore, there is an urgent need for a wider spectrum of novel antidepressants to target newly discovered underlying disease mechanisms. Accumulated evidence has shown that immune inflammation, particularly inflammasome activity, plays an important role in the pathophysiology of MDD. In this review, we summarize the evidence on nuclear receptors (NRs), such as glucocorticoid receptor, mineralocorticoid receptor, estrogen receptor, aryl hydrocarbon receptor, and peroxisome proliferator-activated receptor, in modulating the inflammasome activity and depression-associated behaviors. This review provides evidence from an endocrine perspective to understand the role of activated NRs in the pathophysiology of MDD, and to provide insight for the discovery of antidepressants with novel mechanisms for this devastating disorder.     

抑郁症的睡眠质量及其相关影响因素

目的了解保定市抑郁症睡眠质量特点及其相关影响因素。方法采用多阶段分层整群抽样方法随机抽取≥18周岁的人群，共10073名，用扩展的一般健康问卷（GHQ-12）将调查对象分为高、中、低危险组，以美国精神障碍诊断与统计手册-第四版（DSM—Ⅳ）轴Ⅰ障碍定式临床检查病人版（SCID—L／P）对调查对象进行抑郁症的诊断。以匹兹堡睡眠质量指数（PSQI）评定睡眠质量。结果8773人完成了TPSQI调查，抑郁症现患125例，睡眠障碍（PSQI总分〉7）的发生比率为68．8％；PSQI总分与有无支持群体、社会环境、教育、职业、住房、经济、卫生保健、法律与犯罪等社会心理与环境问题无相关。结论睡眠障碍是抑郁症的常见症状，受社会心理与环境问题的影响较小。