不同年龄抑郁症患者瞬目反射的研究

目的:探讨抑郁症与瞬目反射(BR)的关系。方法:对90例抑郁症(青年和老年各45例)患者及60例正常对照组(青年和老年各30例)进行BR检测。结果:与青年对照组和老年对照组比较,青年抑郁症患者和老年抑郁症患者BR的R2、R2′潜伏期分别显著延长(P<0.001),老年抑郁症患者的波幅与老年对照组、青年抑郁症患者的波幅相比显著升高,差异存在极显著意义(P<0.001)。结论:抑郁症患者存在BR的异常,提示抑郁症患者可能存在脑干功能障碍。     

Genetic and environmental factors in major depression

A study of 48 individuals with major depression in a sample of 443 adoptees has shown that depression is positively but not significantly correlated with a biologic background of affective disorder. Both primary and secondary depression was positively and significantly correlated with several environmental factors. In males, an adoptive home where another individual had an alcohol problem increased depression; in females, death of an adoptive parent prior to adoptee age 19 and an adoptive family where another individual had a behavior disturbance increased depression. Results suggest that the environmental factors occurring prior to adoptees age 18 predisposed to depression.     

Cognitive restructuring and EEG in major depression

Techniques based on cognitive therapy and electroencephalography (EEG) were used to investigate the predictive utility of EEG alpha power with regard to mood improvement. Controls and individuals with major depression participated in four EEG recording blocks. Blocks 1 and 4 were resting baselines. During Block 2, Ss were asked to think about their “most troubling life difficulty.” Next, Ss were introduced to cognitive views of depression and techniques used in cognitive therapy. For Block 3, Ss were asked to use these methods to think again about their life difficulty. Ss who reported greater post- than pre-intervention happiness (i.e., “Responders”) exhibited greater overall cortical activity than Non-responders. Depressed Responders further exhibited a cortical asymmetry of greater right relative to left activity in frontal areas. The predictive utility of EEG is discussed with regard to identifying individuals who show mood improvement following cognitive restructuring.     

Differences in functional connectivity in major depression versus bipolar II depression

Background

Objective methods of differentiating unipolar versus bipolar depression would enhance our ability to treat these disorders by providing more accurate diagnoses. One first step towards developing diagnostic methodology is determining whether brain function as assessed by functional MRI (fMRI) and functional connectivity analyses might differentiate the two disorders.

Methods

Fourteen subjects with bipolar II depression and 26 subjects with recurrent unipolar depression were studied using fMRI and functional connectivity analyses.

Results

The first key finding of this study was that functional connectivity of the right posterior cingulate cortex differentiates bipolar II and unipolar depression. Additionally, results suggest that functional connectivity of this region is associated with suicidal ideation and depression severity in unipolar but not bipolar II depression.

Limitations

The primary limitation is the relatively small sample size, particularly for the correlational analyses.

Conclusions

The functional connectivity of right posterior cingulate cortex may differential unipolar from bipolar II depression. Further, connectivity of this region may be associated with depression severity and suicide risk in unipolar but not bipolar depression.     

Plasma NPY concentrations during tryptophan and sham depletion in medication-free patients with remitted depression

BACKGROUND: Neuropeptide Y (NPY) and serotonergic systems have been implicated in the pathophysiology of depression but have not yet been linked together. METHODS: In a randomized, double-blind crossover study, 28 medication-free patients with remitted depression and 26 healthy control subjects underwent tryptophan depletion (TD) and sham depletion. Plasma NPY concentrations were determined at baseline and at +5, +7, and +24 h during TD and sham depletion, respectively. Hamilton Depression Rating Scale (HDRS, 24-item) scores were assessed at baseline and at +7 and +24 h after TD and sham depletion, respectively. RESULTS: There was no difference between healthy subjects and patients with remitted depression in baseline plasma NPY concentrations and in plasma NPY concentrations during TD and sham depletion, respectively. Plasma NPY concentrations did not differ between TD and sham depletion. At no time point there was an association between HDRS scores and plasma NPY concentrations in patients with remitted depression. LIMITATIONS: Plasma NPY concentrations in rMDD patients were not obtained during the symptomatic phase of the illness. Only peripheral measurements of NPY were used. CONCLUSIONS: Decreased plasma NPY concentrations, as described previously during a spontaneous episode of major depression, appear as state but not as trait marker in depression. No evidence was found for an involvement of plasma NPY in relapse during TD. There appears no direct functional link between serotonergic neurotransmission and plasma NPY concentrations.     

Alteration of cardiac autonomic functions in patients with major depression: a study using heart rate variability measures

BACKGROUND: Depression is associated with greater cardiac morbidity and mortality. One of the contributory factors for this may be altered cardiac autonomic activity in depression. However, cardiac autonomic involvement in depression remains controversial because of methodological issues. In this study, alteration of cardiac autonomic functions was studied in drug-naive patients with major depression without co-morbidity. Heart rate variability, a sensitive measure of neurocardiac autonomic regulation was used in addition to conventional methods of measuring cardiac autonomic functions. METHODS: We recruited 40 patients suffering from major depression, diagnosed based on DSM-IV-TR criteria. Their cardiac autonomic functions were measured using both conventional and heart rate variability measures. These were compared with those of age- and gender-matched healthy controls. RESULTS: Patients with major depression showed significantly lesser Valsalva ratio, maximum/minimum ratio and greater sympathovagal balance than healthy controls indicating decreased parasympathetic and increased sympathetic activity. CONCLUSIONS: Depression is associated with alteration of cardiac autonomic tone towards decreased parasympathetic activity and an increased sympathetic activity. It is possible that a common neurobiological dysfunction contributes to both depression and cardiac autonomic changes in the illness.     

Sensitivity to cholecystokinin-tetrapeptide in major depression

Background: Sensitivity to the panicogenic effects of cholecystokinin-tetrapeptide (CCK-4) is enhanced in panic disorder patients relative to normal controls (NC). In the present study, we determined whether sensitivity to CCK-4 is enhanced in patients with major depressive disorder (MDD) with no history of panic attacks. We also determined whether CCK-4 would exacerbate depressive symptoms. Methods: The study used a double-blind, randomized, placebo-controlled design. Behavioral and cardiovascular response to a submaximal dose (20 μg) of CCK-4 was studied in seven patients with MDD and 12 NC subjects. Results: None of the subjects panicked with placebo, whereas 29% of MDD and 17% of NC subjects panicked with CCK-4. There was no significant difference between groups on the frequency of CCK-4-induced panic or the number and intensity of panic symptoms. No significant difference was detected for cardiovascular response to the CCK-4 challenge. CCK-4 did not worsen depressive symptoms in MDD patients. Limitations: Small number of study subjects. Conclusions: These data indicate that MDD patients show a response to CCK-4 that is comparable to NC. The lack of effect of CCK-4 on depressive symptoms suggest that central CCK receptors may not play an important role in the pathophysiology of MDD.     

Delusional depression. A one year follow-up

Fifty-two unipolar delusional depressives were matched to 52 unipolar nondelusional depressives on the basis of sex, age at index episode of depression and age at first episode of depression. In a one year follow-up after discharge from inpatient treatment, the delusional depressives had a poorer clinical course than the nondelusional depressives as manifested by significantly higher rates both of major depression or delusions lasting longer than 9 months and of being in a major depressive episode at the end of the follow-up period.     

Increased (E)-4-hydroxy-2-nonenal and asymmetric dimethylarginine concentrations and decreased nitric oxide concentrations in the plasma of patients with major depression

Background: (E)-4-Hydroxy-2-nonenal (HNE) is a highly electrophilic end-product of lipid peroxidation. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial nitric oxide synthase (NOS). ADMA is metabolised by dimethylarginine dimethylaminohydrolase (DDAH). DDAH contains a nucleophilic cysteine residue in its active site. There is an increase in lipid peroxidation in major depression. Major depression is associated with the development of coronary heart disease (CHD) and greatly increases morbidity and mortality. There is an increase in circulating ADMA in CHD and vascular risk factors. Objectives: To determine plasma HNE, ADME and nitric oxide (NO) concentrations in patients with major depression compared to normal volunteers and to examine the effect of HNE on ADMA formation and DDAH activity in cultured endothelial cells. Methods: The study was conducted in 25 patients with major depression (DSM-IV criteria) and 25 healthy control subjects. Plasma concentrations of HNE were determined as the O-pentafluorylbenzyl oxime using capillary column GC–MS and deuterated HNE as the internal standard; ADME by LC–MS–MS using ¹³C⁶- -arginine as the internal standard; and NO by GC–MS following reduction to nitrate and nitrite and derivatisation to the pentafluorobenzyl derivative using [¹⁵N]nitrate and [¹⁵N]nitrite as the internal standards. Human umbilical vein endothelial cells were incubated in serum-free medium in the presence of HNE. The concentration of ADMA in the medium was determined by LC–MS–MS. DDAH activity was determined by measuring -citrulline in endothelial cell lysates using LC–MS. Results: There was a significant increase in the plasma concentration of HNE (P<0.0001) and ADMA (P<0.0002) in patients with major depression. There was a significant decrease in the plasma concentration of NO (P<0.0001). A significant positive correlation was found between the plasma concentrations of HNE and ADMA (r=0.63, P<0.0001). A significant negative correlation was detected between the plasma concentrations of ADMA and NO (r=−0.595, P<0.0001). HNE significantly increased ADMA formation (P<0.0001) and significantly decreased DDAH activity (P<0.0001) in cultured endothelial cells. The effects of HNE on DDAH activity were significantly attenuated by the addition of glutathione (P<0.0001). Limitations: No allowance was made for the phase of the menstrual cycle which could influence plasma nitric oxide concentrations. Conclusions: There is an increase in circulating HNE in major depression. HNE inactivates the cysteine residue in the active site of endothelial DDAH leading to the accumulation of ADMA in the circulation. The ADMA then decreases the production of eNOS. This could reduce the amount of NO diffusing from cerebral blood vessels to nearby neurons and influence the release of neurotransmitters. ADMA also constricts cerebral blood vessels and may contribute to the decreased regional perfusion in major depression. The accumulation of ADMA could explain the increased risk of CHD in major depression. The preservation of DDAH activity and the reduction of ADMA accumulation may represent a novel therapeutic approach to the treatment of major depression.     

Neurogenesis and major depression: implications from proteomic analyses of hippocampal proteins in a rat depression model

Major depression is one of the most disabling disorders. Yet, the pathogenesis of this mental disorder is poorly understood. Hippocampus is generally believed to be associated with pathogenesis of depression. In this study, we adopted a proteomic approach to examine possible alterations of protein expression in the hippocampus of a rat depression model. Our results suggest that neurogenesis in hippocampus may play an important role in the pathogenesis of major depression.     

The growth hormone response to apomorphine at 4 days postpartum in women with a history of major depression

We have examined the responsiveness of dopamine sensitive neurones in the postpartum period in woman with a history of major depression who are at high risk of experiencing a recurrence of illness in the postpartum period. Fourteen women were assessed at 36 weeks of pregnancy and during the 3 months following delivery, using the Schedule for Affective Disorders and Schizophrenia, including its change version. They were not depressed at initial assessment. Five of the 14 women went on to experience a postpartum relapse (2 major depressive disorder, 2 generalised anxiety disorder, 1 panic disorder). On the fourth day postpartum, ie before relapse, the growth hormone response to the dopamine agonist apomorphine was measured as an index of the functional state of hypothalamic dopamine D2 receptors. Women who subsequently relapsed had a significantly greater growth hormone response to apomorphine than those who remained well. This was particularly marked in women with anxiety/panic. The development of increased sensitivity of hypothalamic dopamine D2 receptors in the postpartum period appears to predict the onset of depressive and anxiety disorders.     

Target evaluation processing and serum levels of nerve tissue protein S100B in patients with remitted major depression

Selective attention processes (N2 and P3 components of event-related potentials (ERPs)) have been shown to be impaired in depressed patients but findings have been mixed. Part of this variability might be explained by neurobiological factors. ERPs (Go/Nogo paradigm) were investigated in patients with remitted major depression in relation to S100B. S100B, an astroglial protein with neuroplastic properties, has been shown to be increased in depression. Its pathophysiologic role in depression, however, is not yet sufficiently understood. Patients with increased S100B serum levels (n=6) showed a normal N2- and P3-amplitude in contrast to a reduced N2- and P3-amplitude in patients with normal S100B serum levels (n=6). These findings provide evidence of a correlation between S100B levels and attentional processes in patients with recurrent depression and further substantiate S100B's role as a marker in the course of affective disorders.     

Pattern of impaired working memory during major depression

BACKGROUND: The aim of this study was to assess working memory (WM) in patients with major depressive disorder (MDD), using a robust parametric WM task (the n-back task). METHODS: Twenty patients with MDD and twenty healthy controls completed a visual version of the paradigm, comprising four levels of task difficulty (i.e. 0-, 1-, 2-, and 3-back). Performance accuracy and reaction time (RT) were measured at each difficulty level. RESULTS: In comparison with controls, patients with MDD exhibited slower RTs (F((1,38)) = 25.16, p < 0.001), and reduced accuracy (F((1,38)) = 5.93, p < 0.001). There was no diagnosis-specific effect of task difficulty on performance accuracy. However, the faster response to memory (1-3-back) than to shadowing (0-back) tasks observed in controls was not as pronounced in patients. CONCLUSIONS: These observations support a relatively specific impairment of WM/central executive function in MDD, which may potentially mediate the diverse pattern of cognitive dysfunction noted in MDD. The parametric n-back task is applicable to subjects with MDD and yields results interpretable across the dimensions of task difficulty and performance in controls and patients.     

Group interpersonal psychotherapy for patients with major depression disorder - pilot study

Background: This study evaluated the effectiveness of group interpersonal psychotherapy (IPT-G) for patients suffering from moderate to severe major depressive disorder (MDD), and who responded to antidepressant drugs during the acute phase treatment. Method: Subjects were allocated into two groups: in the study group subjects entered IPT-G while in the comparison group subjects continued with standard treatment. All subjects were assessed five times during and 6 months after the termination of the IPT-G in a double-blind, matched-control design. Results: Subjects who participated in the IPT-G demonstrated significant improvement of their depressive symptoms compared to those who received the standard treatment both during the group therapy and in a 6-month follow-up period. Conclusions: Our preliminary results suggest that IPT in a group setting might be effective for a subset of patients who respond to antidepressant medication. Limitation: Small group of patients, lack of different types of treatment as control groups.     

冲突性负波N270对抑郁症患者认知功能损害的评价

目的：揭示抑郁症患者的认知功能损害,探讨在该病患者中冲突性负波N270的变化及意义。方法：顺序出现的颜色相同或不同的刺激对随机呈现。25名抑郁症患者和25名年龄、性别匹配的正常对照并判断每对刺激的颜色是否相同并相应按键反应,同时在头皮记录事件相关电位。结果：在患者组和对照组,颜色不同的刺激对均可诱发出N270。患者组N270的潜伏期延长(P_3、P_4,P＜0．05),且缺失率高于对照组(F_3,5/25；F_4,4/25),各部位N270的峰波幅显著低于对照组。结论：抑郁症患者存在认知功能损害,N270可作为评价该病认知功能障碍的一个指标。     

Cell-mediated immunity in patients with chronic fatigue syndrome, healthy control subjects and patients with major depression.

The chronic fatigue syndrome (CFS) is characterized by severe persistent fatigue and neuropsychiatric symptoms. It has been proposed that the abnormalities in cell-mediated immunity which have been documented in patients with CFS may be attributable to a clinical depression, prevalent in patients with this disorder. Cell-mediated immune status was evaluated in patients with carefully defined CFS and compared with that of matched subjects with major depression (non-melancholic, non-psychotic) as well as healthy control subjects. Patients with CFS demonstrated impaired lymphocyte responses to phytohaemagglutinin (PHA) stimulation, and reduced or absent delayed-type hypersensitivity (DTH) skin responses when compared either with subjects with major depression or with healthy control subjects (P less than 0.05 for each analysis). Although depression is common in patients with CFS, the disturbances of cell-mediated immunity in this disorder differ in prevalence and magnitude from those associated with major depression. These observations strengthen the likelihood of a direct relationship between abnormal cell-mediated immunity and the etiology of CFS.     

Right hemisphere abnormalities in major depression: Quantitative electroencephalographic findings before and after treatment

The quantitative EEGs of drug-free depressed patients were analyzed and compared to age and sex-matched controls, using spectral analysis. In addition, QEEGs of depressed patients after clinical improvement resulting from 6 weeks of antidepressant treatment were also analyzed. The subjects were 20 patients suffering from major depression (DSM-III-R). Scores on the Hamilton Rating Scale for Depression (HRSD) of all patients showed a reduction of more than 50% at the end of the 6th week. The results show: (1) delta and theta bipolar absolute powers of the right hemisphere increased in drug-free depressed patients, compared to controls. (2) No changes in all bands of QEEG were found after clinical improvement resulting from 6 weeks of treatment. These results suggest that the right hemisphere plays an important role in major depression, and that a reduction in symptoms is not necessarily indicative of an improvement in underlying major depression.     

Effects of mental workload on long-latency auditory-evoked-potential,salivary cortisol,and immunoglobulin A

This paper researches on the effects of mental workload on long-latency auditory-evoked-potential (AEP), salivary cortisol, and immunoglobulin A (IgA). 20 Healthy subjects (11 males and 9 females) participated in the experiment voluntarily. The mental task consisted of two parts: arithmetic task and reading comprehension task. The Latencies of N1, P2, N2, P3, and mismatch negativity (MMN) all increased significantly after the mental tasks were adopted at all of the three recording sites: Cz, Fz, and Pz (p < 0.05). In this experiment, changes of salivary cortisol and s-IgA levels due to mental tasks were not significant. With the introduction of mental tasks, more processing resources are allocated to the primary task (mental task), and decreased processing resources available for the secondary task (auditory task), which is reflected on the increases in the latencies of probe-evoked AEP components.     

Associations among depression,suicidal behavior,and quality of life in patients with human immunodeficiency virus

AIM: To investigate the potential associations among major depression, quality of life, and suicidal behavior in human immunodeficiency virus(HIV) patients. METHODS: A detailed MEDLINE search was carried out to identify all articles and book chapters in English published from January 1995 to January 2015. RESULTS: Based on the main findings, the prevalence of major depressive disorder(MDD) ranged from 14.0% to 27.2%. Furthermore, the prevalence of suicidal ideation varied from 13.6% to 31.0% whereas, attempted suicides were reported to range from 3.9% to 32.7%. Interestingly, various associated risk factors for both depression and suicide were identified in HIV patients. Finally, consistent associations were reported among MDD, suicidal ideation, and poor quality of life in individuals living with HIV. CONCLUSION: Although additional studies are needed to elucidate this complex association, our results suggest the importance of early detection of both MDD and suicidality in patients living with HIV.