抑郁症

抑郁症治疗研究新进展

瞿伟，谷珊珊

（第三军医大学西南医院临床心理科 全军心理卫生研究中心，重庆 400038）

An inventory for measuring depression

Beck AT； Erbaugh J； Ward CH； et al.

Collaborative Management to Achieve Treatment Guidelines — Impact On Depression in Primary-Care

Katon W； Vonkorff M； Lin E； et al.

Depression Following Myocardial-Infarction — Impact On 6-Month Survival

Frasuresmith N； Lesperance F； Talajic，M

Reduction of Prefrontal Cortex Glucose-Metabolism Common to 3 Types Of Depression

Baxter LR； Schwartz JM； Phelps ME； et al.

卒中后抑郁状态的发生率及相关因素研究

龙洁，刘永珍，蔡焯基，等

热点追踪

抑郁症

·编者按·

抑郁症是一种常见的情感性精神障碍.据统计，全球约有3.4亿人受其影响，我国的抑郁症患者也已经超过2600万.有研究表明，大约16%的人在其一生中的某个阶段可能经历抑郁发作.此外，抑郁症患者自杀、自伤的危险性非常高.据报道，自杀死亡者中40%患有抑郁症.根据WHO最新报告，预计到2020年，抑郁症将成为导致人类死亡和致残的第二大类疾病.“蓝色隐忧”，让人担忧.

抑郁症又称抑郁障碍，以心境低落为主要的临床特征，可以从不同程度上表现为闷闷不乐、兴趣减退，甚至痛不欲生、悲观绝望.部分病例有明显的焦虑和精神运动型迟滞和激越，意志活动减退，严重者有自杀企图或行为.除情绪症状外，患者还有可能出现睡眠障碍、食欲减退或增强、性欲减退或消失等躯体症状.同时伴发出现记忆力下降、注意力障碍等认知功能缺损.

目前，抑郁症的病因尚未有明确定论，但是可以确定，抑郁症的发生有着明确的生物学特性.此外，心理和社会环境等因素也起到不可忽视的作用.在现代医学模式下，很多研究者从生物、心理和社会三个方面探讨抑郁症的发病机理，并形成了生物-心理-社会的统一模式，其中涉及神经、内分泌以及免疫等方面.具体来说，遗传因素、神经生化改变、神经内分泌假说、抑郁症的细胞因子学说以及心理社会因素都被纳入到抑郁症的发病机制探讨当中.其中，从神经生化学角度探讨抑郁症发病机理的相关研究中，主要将五羟色胺（5-HT）、去甲肾上腺素（norepinephrine，NE）、多巴胺（Dopamine，DA）、乙酰胆碱（acetylcholine，Ach）中的一种或几种归纳为抑郁症发病的相关因素.

目前，药物治疗是最主要的抑郁症治疗方法，在这一部分研究中，很多研究者应用了动物模型，取得了一定的效果.20世纪50～60年代，出现了包括单胺氧化酶抑制剂的第一代抗抑郁药；20世纪80年代，第二代抗抑郁药5- HT再摄取抑制剂诞生.目前，具有抗抑郁作用的中草药也被用于治疗抑郁症.除药物外，社会心理治疗也是常用的方法，常用的社会心理治疗包括：支持性心理治疗、动力学心理治疗、认知治疗、行为治疗、人际心理治疗、婚姻和家庭治疗.此外，对于一些较为严重的状况，还会应用脑部刺激等治疗方法.有研究者指出，联合治疗模式正在成为抑郁症治疗新趋势，主要包括药物治疗与心理治疗的联合模式和药物治疗与物理治疗的联合模式.

本专题得到了袁勇贵主任医师（东南大学附属中大医院）的大力支持.

·热点数据排行·

截至2015年3月23日，中国知网（CNKI）和Web of Science（WOS）的数据报告显示，以抑郁症（depression）为词条检索到的期刊文献分别为11320与44795条，本专题将相关数据按照：研究机构发文数、作者发文数、期刊发文数、被引用频次进行排行，结果如下.

研究机构发文数量排名（CNKI）

研究机构发文数量排名（WOS）

作者发文数量排名（CNKI）

作者发文数量排名（WOS）

期刊发文数量排名（CNKI）

期刊发文数量排名（WOS）

根据中国知网（CNKI）数据报告，以抑郁症（depression）为词条检索到的高被引论文排行结果如下.

国内数据库高被引论文排行

根据Web of Science统计数据，以抑郁症（depression）为词条检索到的高被引论文排行结果如下.

国外数据库高被引论文排行

·推荐综述·*摘编自《第三军医大学学报》2014年36卷11期1113～1117页

抑郁症治疗研究新进展*

瞿伟，谷珊珊

（第三军医大学西南医院临床心理科 全军心理卫生研究中心，重庆 400038）

抑郁症是一种高患病率、高疾病负担、高复发率、高致残率、高自杀率的慢性精神疾病.根据WHO最新报告，预计到2020年，抑郁症将成为导致人类死亡和致残的第二大类疾病.自20世纪80年代以来，抑郁症治疗的研究取得了长足的进步，特别是第 3代抗抑郁药 5-羟色胺再摄取抑制剂的诞生，开启了抑郁症治疗的新篇章，大大增强了药物治疗的安全性、方便性.随后 10年相继研发出第4代5-羟色胺与去甲肾腺素双通道再摄取抑制剂（SNRI类，如万拉法新）、5-羟色胺与去甲肾腺素双通道调节剂（NaSSa类，如米氮平），为医师给患者制订个性化治疗方案提供了更安全、更有效、更多的药物选择.随着基因组学、脑影像学、神经科学研究的深入，2010年《自然》杂志主编PhilipCampbel提出抑郁症是脑部发育性疾病，至此，抑郁症属于功能性疾病的观念被彻底更正，因此，药物治疗仍然是当前抑郁症治疗的主要手段.尽管第3、4代抗抑郁药有更高的治疗缓解率、更好的耐受性而成为一线抗抑郁药物，而且对中、重度抑郁症也具有良好的疗效，但目前一线抗抑郁药物的治愈率仅为30%，导致患者及家属对治疗效果不满意.症状的复燃和复发是抑郁症的病程特征，抑郁症状复燃和复发的原因涉及生理、心理及社会等多种原因，因此，心理治疗作为治疗抑郁症的一个重要手段越来越受到关注.尽管循证研究证实认知行为治疗（cognitive behavioral therapy，CBT）对抑郁症治疗有效，但心理治疗起效是一个渐进、累积产生效应的过程，比药物起效更慢，因此，患者早期往往难以耐受逐渐起效的过程，甚至难以相信心理治疗的效果，而更愿意接受药物治疗.抑郁症的物理治疗包括电休克治疗（electroconvulsive therapy，ECT）、迷走神经刺激（vagusnerve stimulation，VNS）及经颅磁刺激（transcranial magnetic stimulation，TMS）等，其中改良型无抽搐电休克治疗（modified electroconvulsive therapy，MECT）抑郁症的有效率达70%～90%.研究显示不同的物理治疗其疗效也因人而异.无论是药物治疗、心理治疗，还是物理物治疗均提示有效，但临床实际效果不尽如人意，而且同样的药物、同样的治疗方法，不同人却疗效不同，是什么原因导致疗效的差异？还有哪些因素影响着疗效与结局？如何提升抑郁症治疗的疗效？这对患者和医师都具有非常重要的意义.越来越多的研究证据表明抑郁症是一种病因、机制及疗效异质性很大的疾病，很多学者发现患者依从性、治疗偏好等因素均对治疗结局产生微妙而重要的影响，现就对近年来抑郁症治疗领域研究中出现的新理念、新趋势、新进展展开述评.

1抑郁症治疗管理新理念

1.1基于评估治疗（measurement-based care，MBC）模式被推荐

虽然循证医学及美国精神病协会抑郁障碍防治指南对抑郁症治疗过程评估作出了规范的推荐，但临床实践与规范推荐之间仍有较大差异.过去基于经验性治疗方式、治疗方法及治疗过程不规范，医院之间及医师之间诊治水平相差大，抗抑郁药物治疗用量不充分、疗程不完整，常规评估未广泛实施，导致患者或医师对临床症状、社会生活功能了解不充分、不全面，患者往往根据自己主观症状改善而自行停药，或医师根据患者症状改善的描述而过早减少药物剂量或停药，导致较难达到抑郁症的治疗目标.在此背景下，MBC治疗模式或量化治疗模式应运而生.国外学者提出 MBC治疗是精神科或心理科临床获得更高疗效的有效策略.MBC是一种在临床实践中实施循证医学路径的治疗模式，由以下几部分组成：①准确评估症状及严重程度，确保足够的抗抑郁药物剂量；②评估药物的耐受性、监测药物不良反应，确保治疗的安全性；③评估还包括患者社会、心理及生活功能损害和恢复状态，以确定治愈的程度.MBC治疗模式在慢性病如糖尿病、高血压管理中早已被广泛使用，医师根据临床量化指标及时调整药物剂量或治疗方案，以提高医疗质量，改善患者转归.精神科最早在抑郁症的序贯治疗研究（sequenced treatment alternatives to relieve depression*，STAR*D）中推广使用MBC，采用简单、可信的工具对患者的症状、不良反应、安全性等方面进行系统评估.MBC在精神科的治疗实用性和有效性已在多个临床研究及临床实践中被验证.2010年版美国精神病学会（American psychiatric association，APA）抑郁症治疗指南推荐将MBC加入抑郁症疾病的管理，2012年第5版《精神疾病诊断与统计手册》（DSM-Ⅴ）指出：精神疾病的评估是DSM-Ⅴ的工作目标和重大更新之一.

目前，国外研究证明患者健康问卷-9项量表（patient health questionnaire-9，PHQ-9）是一种简单、有效的评估工具.PHQ-9量表由9个条目组成，包括抑郁症核心症状、生活、社会、心理功能，可以协助医师判断是否抑郁，以及抑郁严重程度，医师可根据其评分结果决定后续治疗方案，通过评估避免患者和医师停留在疾病主观感觉的认识上，而让患者和医师对疾病状态的变化有客观、量化、系统、全面的认识，提高患者的依从性，从而提高临床疗效.MBC在国内精神科领域仍是一个较新的概念.2013年第十届中国神经精神科年会上王刚教授在报告中谈到，采用随机、对照方式验证了MBC治疗模式的有效性，其研究证实量化治疗组在整体有效性和服药依从性方面均显著优于常规治疗组，量化治疗作为一种更加系统、规范、高效标准化的治疗模式，已成为精神科治疗的新模式.

1.2提高依从性作为治疗的重要策略被提出

药物治疗是控制症状和预防复发的主要手段.有研究表明，首次抑郁发作的患者其复发率至少为50%，已有2次抑郁发作的患者其复发率则高达80%～90%.研究显示，在临床抗抑郁药治疗研究中，未依从医师治疗方案的患者达40%～70%，而且随着治疗时间越长，患者依从性比例呈递减趋势，抑郁症脱落率高达50%～70%.不依从行为包括患者自行减少药物剂量或提前中断治疗等.抑郁症是一种慢性疾病，决定了其需要长期治疗的必要性.APA抑郁症治疗指南中推荐治疗分4期：急性治疗期、巩固治疗期、维持治疗期、撤药治疗期，完成4个治疗周期一般需要1～2年，甚至更长，对患者、家属来说是一个很大的挑战.有学者提出患者依从性比有效的治疗方案更重要.因此，患者依从性成为影响临床疗效的关键因素之一.影响患者依从性因素包括患者因素、药物因素及疾病因素.其中患者因素包括对疾病的态度、患者治疗偏好等，成为影响患者依从性的中介调节因素.药物因素包括药物吞服困难、日服药的次数、服药方法的复杂性、同时服药的种类、药物引起不良反应的严重程度、药物的物理性状等.疾病的因素包括对疾病的认知、对共患病的认识、对药物疗效的了解、对治疗起效时间的了解、对潜在不良反应的了解、对症状改善的简单认识等.研究显示良好的依从性有助于提高临床治愈率.因此，2010年APA在抑郁症治疗推荐指南中增设了患者和家属教育这一项，将提高依从性作为治疗的重要策略提出.教育内容包括疾病基本知识、治疗方法及疗效、药物服用方法、药物副作用应对、疗程、对治愈的识别与理解等，其目的是尽可能让患者参与到治疗决策中来，从而提高患者的依从性.

1.3患者治疗偏好作为治疗策略被建议

随着健康理念不断更新，治疗中患者个人更倾向于某种治疗方式或者某种治疗药物，这一患者治疗偏向的概念在临床实践中得以广泛应用.在临床实践中，医师往往选择对患者最重要、最有价值、最大获益的治疗，但某些研究，包括STAR*D研究得到的数据显示，患者对治疗的不同偏好会导致治疗反应差异很大.2012年Steidtmann等对患者选择匹配和不匹配治疗结局效应值的荟萃分析发现，主动接受医师制订治疗方案的患者比未接受或被动接受医师制订治疗方案的患者退出治疗的可能性减少1/3～1/2，接受医师制订治疗方案的患者不仅退出更少，而且临床改善更快、结局更好.这提示患者治疗偏好可通过影响依从性和合作性而最终影响治疗结局.研究显示，抑郁起效与治疗偏好有关，仅选择药物治疗的患者预后不佳，患者治疗偏好是其疗效不佳和脱落的预测因子.研究表明，40%～60%的抑郁症患者选择药物联合心理治疗，而 20%～40%的抑郁症患者没有治疗的偏好，其中偏向药物治疗往往更易脱落，偏向心理治疗的患者依从性更高.患者偏好受年龄、疾病种类、花费、服药方便性等多种因素影响.在治疗上有偏向性的患者特征：年龄偏大，更加认同抑郁症是一种疾病，既往服用抗抑郁药的比例更高，既往发作次数更多，既往就诊率更高，且在治疗3个月即呈现出更快的症状改善.这些研究结果给临床医师提供了一个有益的启发，重视和利用患者治疗偏好是提高临床疗效的策略之一.

1.4早期起效作为提高疗效的重要策略被强调

抑郁症治疗早期疗效一般在2～4周起效.抑郁症治疗起效慢一直困扰着患者、家属和医师，不但延长和加重患者及家属痛苦，增加经济负担，而且易导致患者对治疗失去信心，中断治疗，从而降低依从性.研究发现，有些抗抑郁药物可以在2周内起效，且快速起效与最终治疗结局密切相关.一项包括1982—2003年42项临床试验、纳入了6562例抑郁症患者、评估抗抑郁药物能否预测患者预后的荟萃分析研究显示，研究结束时在获得稳定临床治愈者中92%（1084/1172）为早期改善者，早期的疗效可以有效预测临床预后，早期疗效预测稳定疗效及临床治愈率的敏感度分别在81%和87%以上.一项前瞻性、多中心的包括705例抑郁症住院患者的研究采用汉密顿抑郁自杀因子（Hamilton depression rating scale for depression，HAMD-3）评分，评估患者早期疗效与自杀意念的关系，发现早期无效患者自杀意念的发生率比早期有效患者升高3～5倍，而且早期有效患者显著降低了悲观情绪.这些研究给临床医师启示：在抗抑郁治疗的同时，选择起效快、临床治愈率高的药物可以更快改善患者的症状，减轻患者的痛苦，降低自杀的风险，从而增加患者依从性；早期起效是抑郁症早期治疗的重要策略之一.

2联合治疗模式成为抑郁症治疗新趋势

2.1药物治疗与心理治疗联合模式

抗抑郁药物仅对1/3的患者完全有效，循证研究已表明CBT治疗不仅对治疗抑郁症有效，而且可通过改变患者抑郁认知模式、纠正其不合理信念从而降低复发率，但心理治疗起效更慢，导致很多患者并不接受治疗.什么样的方法既能快速起效，又能降低复发率，提升疗效的稳定性呢？过去50年的精神病学实践见证了精神药物的迅速发展，同时心理治疗也得到了越来越多的重视.大量证据显示药物治疗和心理治疗联合方式可以更好地改善抑郁症状及其预后.2013年Wiles等的研究表明：在综合医院难治性抑郁症药物中辅以CBT治疗，在治疗6个月时，联合CBT治疗组患者有效性比常规药物治疗组增加了3倍，提示药物治疗与心理治疗联合使患者的获益更多.研究显示，在初始药物治疗失败的情况下，最佳治疗选择是药物治疗与心理治疗联合.心理治疗方法很多，在临床实践中，医师会根据患者的具体情况而选择不同的心理治疗方法，如精神分析、家庭治疗、人际关系治疗以及团体治疗等.除了CBT治疗被循证医学证实是有效的方法外，其他心理治疗方法，如精神分析、系统家庭治疗、人际关系治疗等均在抑郁症患者中应用，但其治疗效果受患者个体因素及医师因素影响很大，而且心理治疗更强调个案化，因此，至今尚少见大样本或循证研究证实精神分析、家庭治疗对抑郁症治疗有效，但并不能否定或低估精神分析、家庭治疗以及人际关系治疗抑郁症有效的事实.事实上，临床较多患者在接受家庭治疗后，家庭沟通模式得到改善，家庭成员增加了对患者抑郁症的认识，从而改变了自己行为，家庭人际关系随之变得友善、包容、互助；一些患者在接受人际关系治疗后，学习了基本人际交往技巧，使自己变得自信起来，改变了自卑和压抑，从而抑郁情绪得到了改善.临床常见现象是家庭成员对患者越能理解和关心，患者症状改善更快而且维持疗效越好，否则即使暂时好转，也难以维持疗效的稳定.因此，药物治疗联合心理治疗成为抑郁症治疗领域的新趋势.早期通过药物治疗改善患者睡眠，躯体症状以及缓解抑郁、焦虑情绪，后期实施心理治疗，纠正患者不合理观念，提高患者对自我的认识与理解，从而更全面改变患者抑郁状态，提升患者生活质量.然而，开展心理治疗需要医师接受系统理论和操作技能的培训，还需考虑医师的经验、伦理、法律，以及患者对心理治疗的感受与信念等诸多问题.心理治疗被倡导和重视，终将推动抑郁症临床治疗模式的改变和完善.此外，由于CBT治疗需要医患双方面对面，并且需要很长时间、多次，甚至长达几十次的面谈，患者心理阻抗比较大，为CBT治疗带来很大阻力和不便，能长期坚持治疗对患者来说具有很大挑战.一种新的心理治疗方式——电话CBT治疗引起了学者的兴趣与关注.Mohr等发现，在18个月治疗过程中，电话访谈和面谈均能降低HMAD和PQH-9评分，但6个月时面谈患者HMAD和PQH-9评分均优于电话访谈患者.在18个月治疗过程中，与面谈患者相比，接受电话访谈患者终止治疗的比例更少，电话访谈和面谈脱落率差异有统计学意义（20.9% vs 32.7%，P=0.02），前5个月中，面谈较电话访谈脱落率更高（4.3% vs 13.3%）.该研究显示，非传统心理干预方式在抑郁症治疗中显示出其积极的价值.

2.2药物治疗联合物理治疗

大脑中电脉冲是信息加工与传递的基础，因此，大脑电刺激或脉冲的改变在理论上能够改变大脑局部神经生化学的变化，从而改变大脑局部的功能.精神医学正处于快速发展的阶段，对精神疾病的机制及治疗手段研究近几年不断推陈出新.在精神科具有代表性的物理治疗手段包括ECT、VNS及TMS等.ECT是整个新物理治疗家族中的鼻祖，是APA指南推荐的严重抑郁症的治疗选择.ECT联合药物治疗是治疗新发抑郁症的有效手段，但有研究表明ECT与急性和部分慢性记忆缺失相关，故未能被充分利用.而MECT总体疗效与传统ECT疗效相当，且对记忆的影响较少，易被患者及家属接受，目前在临床得以推广.在2011年164届美国精神病年会上有学者报告MECT可以早期用于抑郁症患者，能快速改善抑郁症患者的临床症状.TMS是20世纪80年代中期发展起来的一种影响和改变大脑功能的生物刺激技术，已有研究证实其治疗抑郁症的安全性及有效性，对初始药物治疗失败的患者，TMS治疗被APA推荐为抑郁障碍的治疗方法之一.VNS是不适用于绝大多数其他治疗方法的长期（慢性）抑郁症患者的最佳治疗选择，被FDA批准用于治疗难治性抑郁.在临床实践中，有医师针对患者个体化特征，采取药物治疗、心理治疗、物理治疗3种治疗方法联合，同样收到一定效果.

3展望

目前研究显示，抗抑郁药有效率仅为60%～80%，治愈率也仅为30%，起效时间2～4周.近年，药物研究最新的热点是氯胺酮的快速起效.研究表明氯胺酮治疗抑郁症4～72 h治疗有效率及治愈率平均为77%和43%，但维持疗效时间较短.因此，抗抑郁药仍然存在起效较慢、治愈率不高的问题，不能满足患者对治疗及时起效的需要以及对治疗结局的期待.如何提升其疗效的持久性与稳定性已成为该领域研究热点.此外，临床医师如认识到患者依从性、治疗偏好、早期起效等因素都潜在影响着治疗的效果，不仅拓展了其临床思维和视野，而且为其提供了新的治疗策略和循证治疗依据.医师将这些影响因素纳入对疾病的管理和处置考虑中，将显示出比既往更好的治疗效果，这些重要发现对完善、规范抑郁症的临床治疗有很大的指导意义.无论从病因学、疾病机制、流行病学、临床现象学，还是治疗学等方面考虑，抑郁症都是一种复杂、异质性很大的精神疾病.对抑郁症的遗传学、神经回路标记或心理学标记潜在价值目前也不清楚，这些问题有望在将来得到澄清.即使这些问题得到澄清，不同的患者需要哪种治疗方法，同样需要医师借助大量的临床研究资料和丰富临床经验，对患者进行全面判断，做出治疗决策时必须权衡科学证据，并了解药理学和心理学知识，确保选择最好的治疗措施.因此，对抑郁症的治疗不仅需要从生物层面，从心理、社会的层面进行，还需要有一个完整的康复体系，全面提升抑郁症患者生理、心理、社会功能.今后抑郁症治疗模式是精神科医师、心理治疗师、社会工作者三方联合，以便真正提高抑郁症的治愈率，使抑郁症的整体发病率及致残率降低.

·经典文献推荐·

基于Web of Science检索结果，利用Histcite软件选取LCS（Local Citation Score，本地引用次数）TOP 30文献作为节点进行分析，得到本领域推荐的经典文献如下.

来源出版物：Journal of Neurology Neurosurgery and Psychiatry，1960，23（1）： 56-62

An inventory for measuring depression

Beck AT； Erbaugh J； Ward CH； et al.

Abstract： The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanickin a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective，measurable and verifiable criteria of classification based not on personal or parochial considerations，but on behavioral and other objectively measurable manifestations."

来源出版物：Archives of General Psychiatry，1961，4（6）： 561-571

Collaborative Management to Achieve Treatment Guidelines — Impact On Depression in Primary-Care

Katon W； Vonkorff M； Lin E； et al.

Abstract： Objective： To compare the effectiveness of a multifaceted intervention in patients with depression in primary care with the effectiveness of ''usual care'' by the primary care physician.

Design： A randomized controlled trial among primary care patients with major depression or minor depression.

Patients： Over a 12-month period a total of 217 primary care patients who were recognized as depressed by their primary care physicians and were willing to take antidepressant medication were randomized，with 91 patients meeting criteria for major depression and 126 for minor depression.

Interventions： lntervention patients received increased intensity and frequency of visits over the first 4 to 6 weeks of treatment（visits 1 and 3 with a primary care physician，visits 2 and 4 with a psychiatrist）and continued surveillance of adherence to medication regimens during the continuation and maintenance phases of treatment. Patient education in these visits was supplemented by videotaped and written materials.

Main Outcome Measures： Primary outcome measures included short-term（30 day）and long-term（90 day）use of antidepressant medication at guideline dosage levels，satisfaction with overall care for depression and antidepressant medication，and reduction in depressive symptoms.

Results： In patients with major depression，the intervention group had greater adherence than the usual care controls to adequate dosage of antidepressant medication for 90 days or more（75.5% vs 50.0%； P＜0.01），were more likely to rate the quality of the care they received for depression as good to excellent（93.0% vs 75.0%； P＜0.03），and were more likely to rate antidepressant medications as helping somewhat to helping a great deal（88.1% vs 63.3%； P＜0.01）. Seventy-four percent of intervention patients with major depression showed 50% or more improvement on the Symptom Checklist-90 Depressive Symptom Scale compared with 43.8% of controls（P＜0.01），and the intervention patients also demonstrated a significantly greater decrease in depression severity over time compared with controls（P＜0.004）. In patientswith minor depression，the intervention group had significantly greater adherence than controls to adequate dosage of antidepressant medication for 90 days or more（79.7% vs 40.3%； P＜0.001）and more often rated antidepressant medication as helping somewhat to helping a great deal（81.8% vs 61.4%； P＜0.02）. However，no significant differences were found between the intervention and control groups in the percentage of patients who were satisfied with the care they received for depression（94.4% vs 89.3%），in the percentage who experienced a 50% or more decrease in depressive symptoms，or in the decrease of depressive symptoms over time.

Conclusion： A multifaceted intervention consisting of collaborative management by the primary care physician and a consulting psychiatrist，intensive patient education，and surveillance of continued refills of antidepressant medication improved adherence to antidepressant regimens in patients with major and with minor depression. It improved satisfaction with care and resulted in more favorable depressive outcomes in patients with major，but not minor，depression.

来源出版物：JAMA-Journal of the American Medical Association，1995，（273）： 1026-1031

Depression Following Myocardial-Infarction — Impact On 6-Month Survival

Frasuresmith N； Lesperance F； Talajic，M

Abstract： Objective： To determine if the diagnosis of major depression in patients hospitalized following myocardial infarction（MI）would have an independent impact on cardiac mortality over the first 6 months after discharge.

Design： Prospective evaluation of the impact of depression assessed using a modified version of the National Institute of Mental Health Diagnostic Interview Schedule for major depressive episode. Cox proportional hazards regression was used to evaluate the independent impact of depression after control for significant clinical predictors in the data set.

Setting： A large，university-affiliated hospital specializing in cardiac care，located in Montreal，Quebec.

Patients： All consenting patients（N=222）who met established criteria for MI between August 1991 and July 1992 and who survived to be discharged from the hospital. Patients were interviewed between 5 and 15 days following the MI and were followed up for 6 months. There were no age limits（range，24 to 88 years； mean，60 years）. The sample was 78% male.

Primary Outcome Measure： Survival status at 6 months.

Results： By 6 months，12 patients had died. All deaths were due to cardiac causes. Depression was a significant predictor of mortality（hazard ratio，5.74； 95% confidence interval，4.61 to 6.87； P=0.0006）. The impact of depression remained after control for left ventricular dysfunction（Killip class）and previous MI，the multivariate significant predictors of mortality in the data set（adjusted hazard ratio，4.29；95% confidence interval，3.14 to 5.44； P=0.013）.

Conclusion： Major depression in patients hospitalized following an MI is an independent risk factor for mortality at 6 months. Its impact is at least equivalent to that of left ventricular dysfunction（Killip class）and history of previous MI. Additional study is needed to determine whether treatment of depression can influence post-MI survival and to assess possible underlying mechanisms.

来源出版物：JAMA-Journal of the American Medical Association，1993，（270）： 1819-1825

Reduction of Prefrontal Cortex Glucose-Metabolism Common to 3 Types Of Depression

Baxter LR； Schwartz JM； Phelps ME； et al.

Abstract： Using positron emission tomography，we studied cerebral glucose metabolism in drug-free，age- and sex-matched，right-handed patients with unipolar depression（n=10），bipolar depression（n=10），obsessive-compulsive disorder（OCD）with secondary depression（n=10），OCD without major depression（n=14），and normal controls（n=12）. Depressed patients were matched for depression on the Hamilton Depression Rating Scale，and subjects with OCD without depression and OCD with depression had similar levels of OCD without depression and OCD with depression had similar levels of OCD pathology. We also studied six non-sex-matched patients with mania. Mean（±SD）glucose metabolic rates for the left dorsal anterolateral prefrontal cortex，divided by the rate for the ipsilateral hemisphere as a whole（ALPFC/hem），were similar in the primary depressions（unipolar depression =1.05±0.05； bipolar depression =1.04±0.05），and were significantly lower than those in normal controls（1.12±0.06）or OCD without depression（1.15±0.05）. Results for the right hemisphere were similar. Values in subjects with OCD with depression（1.10±0.05）were also significantly lower than in subjects with OCD without depression，and values in subjects with bipolar depression were lower than those in manic subjects（1.12±0.03）on this measure in the left hemisphere，although results were not significant in the right hemisphere. There was a significant correlation between the HAM-D score and the left ALPFC/hem. With medication for depression（n=12），the left ALPFC/hem increased significantly and the percentage change in the Hamilton scale score correlated with the percentage change in the left ALPFC/hem.

来源出版物：Archives of General Psychiatry，1989，（46）： 243-250

·高被引论文摘要·

被引频次：646

卒中后抑郁状态的发生率及相关因素研究

龙洁，刘永珍，蔡焯基，等

目的：了解卒中后抑郁状态（PSD）的发生率及其相关因素.方法：采用Hamilton抑郁量表和自制一般情况调查表，对520例脑卒中患者进行调查评分，并用逐步 Logistic回归统计方法对各相关因素进行分析.结果：PSD总发生率为34.2%，其中轻度20.2%，中度10.4%，重度3.7%.对 PSD影响最大的相关因素是既往抑郁症史，其次是性别、家庭和睦情况、合并疾病种类、神经功能缺损严重程度和卒中后病程.结论：上述因素是本组PSD患者的主要预测因素，为预防PSD提供参考依据.

脑血管意外；抑郁症；Logistic模型

来源出版物：中华神经科杂志，2001，34（3）： 145-148

被引频次：175

脑卒中后抑郁症的前瞻性研究

张通，孟家眉，项曼君

摘要：对81例初发大脑半球卒中患者于急性期和发病后3、6、12个月进行连续随访，旨在观察脑卒中后抑郁症的发生、演变情况及影响抑郁症的因素.结果显示：（1）抑郁症在病后第3个月时总体评分最高，以后随时间推移有下降趋势；（2）病灶最前点愈接近额极，对抑郁症的影响愈大；（3）神经功能缺损的严重程度、合并症、生活状态、照料人是影响抑郁症的主要相关因素，而病灶所在的大脑半球、CT扫描上显示的陈旧病灶、性别、年龄等与抑郁症的发生无明显相关性.

关键词：脑血管意外；抑郁症

来源出版物：中华精神科杂志，1996，29（2）： 73-76

被引频次：173

1977例抑郁症患者中医不同证候构成比分析

胡随瑜，张宏耕，郑林，等

摘要：目的：了解抑郁症中医证候类型的构成比例，为建立抑郁症常见中医证候标准提供依据.方法：采用临床流行病学调查方法，对湖南、天津、北京、哈尔滨、深圳、广西、福建、贵州等南北方8个调查点1977例情感性障碍抑郁发作患者进行了中医辨证及证候指标调查.结果：抑郁症患者存在12种证候类型，依据其构成比大小，排前4位的依次是：肝郁气滞证29.7%，肝郁脾虚证24.5%，肝郁痰阻证13.4%，心脾两虚证12.8%.结论：抑郁症的常见中医证候是肝郁气滞、肝郁脾虚、肝郁痰阻、心脾两虚证4类，在抑郁症常见中医证型与单相障碍4亚型之间存在一定关系.

关键词：抑郁症；临床流行病学；中医证候；构成比

来源出版物：中国医师杂志，2003，5（10）： 1312-1314

被引频次：157

产后抑郁症

陈燕杰，钟友彬

摘要：产后抑郁症发病率国外报道为3.5%～33%，国内报道为3.8%～16.7%.临床表现涉及情绪、认识、行为、生活等几个方面，特点为产后2周发病，4～6周症状明显.主要特征是以婴儿、丈夫相关事为主，一般认为病因是多因素的.但是，产妇分娩前后体内的内分泌变化及产妇的个性心理特点，是产后抑郁症发生的重要先决条件，一些应激性生活事件和产前产时的并发症又是产后抑郁症的主要促发因素.目前，诊断尚缺乏客观指标，多依据各种症状自评量表，由产妇自填后以相应的评分结果判定.主要是心理治疗，约1/3的患者需药物治疗.

关键词：抑郁症；产后；病因；防治

来源出版物：实用妇产科杂志，2000，16（1）： 13-15

被引频次：125

脑卒中后的抑郁症

李根华

摘要：对脑卒中后抑郁症表现的发生率、发病机理、临床特征、诊断及治疗作一概述，以引起神经内科医师及精神科医学界的重视.

关键词：脑卒中；抑郁症

来源出版物：国外医学（脑血管疾病分册），1996，4（1）： 22-24

被引频次：125

卒中后抑郁症研究现状

冯蓓蕾，王翘楚，顾丽芳

摘要：卒中后抑郁症是指卒中发生后，以情绪低落、兴趣减退为主的病症.其发生率为22%～79%，与病灶部位、病人的个性、社会、家庭、卒中后遗症等因素有关，发病机制尚不清楚，临床分轻、重两型.目前研究认为，积极治疗对卒中预后有一定作用.

关键词：卒中；抑郁症；卒中后抑郁症

来源出版物：国外医学（脑血管疾病分册），1999，7（1）： 14-16

被引频次：123

抑郁症与中医“郁证”的关系探讨

曲淼，唐启盛

摘要：结合古代文献及临床研究，从文献记载和临床症状、病因病机等方面论述抑郁症与郁证的差异及共性.认为中医“郁证”本身含有两层含义，一为以病机而立病名，二为情志之病，中医有关抑郁症的描述只见于后者，而且有关抑郁症的描述也在多种中医病名的症状群中出现，因此抑郁症与郁证二者不是简单的等同关系.并提出抑郁症中医辨证应以虚证为纲，结合临床观察，以益肾补虚为大法治疗抑郁症，取得了较好的疗效.

关键词：抑郁症；郁证；关联研究

来源出版物：北京中医药大学学报，2004，27（1）： 11-13

被引频次：121

针刺治疗抑郁症及其对患者下丘脑-垂体-肾上腺轴的影响

徐虹，孙忠人，李丽萍，等

摘要：目的：明确针刺治疗抑郁症的临床疗效，探讨针刺抗抑郁作用的神经内分泌学机制.方法：将60例抑郁症患者随机分为针刺组和药物治疗对照组.针刺组针刺内关、太冲、三阴交等穴治疗4周，对照组口服帕氟西汀治疗4周，在治疗前后分别作地塞米松抑制试验（DST），并检测血浆皮质醇和促肾上腺皮质激素（ACTH）的浓度.结果：针刺治疗抑郁症愈显率约73%，且不良反应小；两组血浆皮质醇和ACTH浓度，在治疗前后差异均有显著性意义.

关键词：抑郁症/针灸疗法；氢化可的松/血液；促肾上腺皮质激素/血液

来源出版物：中国针灸，2001，24（2）： 78-80

被引频次：121

产后抑郁症的筛查标准及发病因素探讨

金燕志，彭涛，王联，等

摘要：分析了我院1992年2月1日～4月30日住院分娩产妇中167例应用艾氏产后抑郁量表（EPDS）的情况，并分析其发病因素.其产后抑郁症阳性率为11.38%（19/167），真阳性率为15.25%（9/59）.EPDS在产后抑郁症的筛查中其灵敏性高，对高危妇女的筛查是可行的，使患者得到尽早发现及治疗.产后抑郁症的发病因素与社会的支持及夫妻关系有密切关系.其症状往往与关于婴儿或丈夫的事为主，表现爱哭，孤僻，悲观厌世，犯罪感等，在产后4～6周明显，持续2周～3个月，严重者可发展为产后精神病，影响母婴的身心健康.

关键词：产后；抑郁症；艾氏产后抑郁量表

来源出版物：中国妇幼保健，1995，10（5）： 287-288

被引频次：17200

A rating scale for depression

Hamilton M

Abstract： 参见本期“经典文献推荐”栏目

被引频次：16720

An inventory for measuring depression

Beck AT； Erbaugh J； Ward CH； et al.

Abstract： 参见本期“经典文献推荐”栏目

被引频次：12142

The hospital anxiety and depression scale

Zigmond，AS ； Snaith，RP

Abstract： A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.

来源出版物：Acta Psychiatrica Scandinavica，1983，67（6）： 361-370

被引频次：5840

New depression scale designed to be sensitive to change

Montgomery SA； Asberg M

Abstract： The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inner-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression，the Hamilton Rating Scale（HRS），indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS，indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.

来源出版物：British Journal of Psychiatry，1979，134（4）： 382-389

被引频次：5111

Development and validation of a geriatric depression screening scale： a preliminary report

Yesavage JA； Brink，TL； Rose TL； et al.

Abstract： A new Geriatric Depression Scale（GDS）designed specifically for rating depression in the elderly was tested for reliability and validity and compared with the Hamilton Rating Scale for Depression（HRS-D）and the Zung Self-Rating Depression Scale（SDS）. In constructing the GDS a 100-item questionnaire was administered to normal and severely depressed subjects. The 30 questions most highly correlated with the total scores were then selected and readministered to new groups of elderly subjects. These subjects were classified as normal，mildly depressed or severely depressed on the basis of Research Diagnostic Criteria（RDC）for depression. The GDS，HRS-D and SDS were all found to be internally consistent measures，and each of the scales was correlated with the subject's number of RDC symptoms. However，the GDS and the HRS-D were significantly better correlated with RDC symptoms than was the SDS. The authors suggest that the GDS represents a reliable and valid self-rating depression screening scale for elderly populations.

来源出版物：Journal of Psychiatric Research，1983，17（1）： 37-49

被引频次：4715

A self-rating depression scale

Zung WWK

Abstract： The fact that there is a need for assessing depression，whether as an affect，a symptom，or a disorder is obvious by the numerousscales and inventories available and in use today.The need to assess depression simply and specifically as a psychiatric disorder has not been met by most scales available today. We became acutely aware of this situation in a research project where we needed to correlate both the presence and severity of a depressive disorder in patients with other parameters such as arousal response during sleep and changes with treatment of the depressive disorder. It was felt that the general depression scales used were insufficient for our purpose and that the more specific scales were also inadequate. These inadequacies related to factors such as the length of a scale or inventory being too long and too time consuming，especially for a patient.

来源出版物：Archives of General Psychiatry，1965，12（1）： 63-70

被引频次：3676

Influence of life stress on depression： Moderation by a polymorphism in the 5-HTT gene

Caspi A； Sugden K； Moffitt TE； et al.

Abstract： In a prospective-longitudinal study of a representative birth cohort，we tested why stressful experiences lead to depression in some people but not in others. A functional polymorphism in the promoter region of the serotonin transporter（5-HTT）gene was found to moderate the influence of stressful life events on depression. Individuals with one or two copies of the short allele of the 5-HTT promoter polymorphism exhibited more depressive symptoms，diagnosable depression，and suicidality in relation to stressful life events than individuals homozygous for the long allele. This epidemiological study thus provides evidence of a gene-by-environment interaction，in which an individual's response to environmental insults is moderated by his or her genetic makeup.

Keywords： serotonin transporter； major depression； mood disorders； events； history； perspectives； liability； genomics； onset

来源出版物：Science，2003，301（5631）： 386-389联系邮箱：Caspi，A； t.moffitt@iop.kcl.ac.uk

被引频次：3494

The PHQ-9 - Validity of a brief depression severity measure

Kroenke K； Spitzer RL； Williams JBW

Abstract： Objective： While considerable attention has focused on improving the detection of depression，assessment of severity Is also important in guiding treatment decisions. Therefore，we examined the validity of a brief，new measure of depression severity. Measurements： The Patient Health Questionnaire（PHQ）is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module，which scores each of the 9 DSM-IV criteria as "0"（not at all）to "3"（nearly every day）. The PHQ-9 was completed by 6，000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey，self-reported sick days and clinic visits. and symptom-related difficulty. Criterion validity was assessed against an Independent structured mental health professional（MHP）interview in a sample of 580 patients. Results： As PHQ-9 depression severity Increased，there was a substantial decrease in functional status on all 6 SF-20 subscales. Also，symptom-related difficulty，sick days，and health care utilization increased. Using the MHP reinterview as the criterion standard，a PHQ-9 score greater than or equal to 10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5. 10，15. and 20 represented mild，moderate，moderately severe，and severe depression，respectively. Results were similar in the primary care and obstetrics-gynecology samples. Conclusion： In addition to making criteria-based diagnoses of depressive disorders，the PHQ-9 Is also a reliable and valid measure of depression severity. These characteristics plus Its brevity make the PHQ-9 a useful clinical and research tool.

Keywords： depression； diagnosis； screening； psychological tests； health status

来源出版物：Journal of General Internal Medicine，2001，16（9）： 606-613

被引频次：2884

The epidemiology of major depressive disorder - Results from the National Comorbidity Survey Replication（NCS-R）

Kessler RC； Berglund P； Demler O； et al.

Abstract： Context Uncertainties exist about prevalence and correlates of major depressive disorder（MDD）.

Objective： To present nationally representative data on prevalence and correlates of MDD by Diagnostic and Statistical Manual of Mental Disorders，Fourth Edition（DSM-IV）criteria，and on study patterns and correlates of treatment and treatment adequacy from the recently completed National Comorbidity Survey Replication（NCS-R）.

Design： Face-to-face household survey，conducted from February 2001 to December 2002.

Setting： The 48 contiguous United States.

Participants： Household residents ages 18 years or older（N=9090）who responded to the NCS-R survey.

Main： Outcome Measures Prevalence and correlates of MDD using the World Health Organization's（WHO）Composite International Diagnostic Interview（CIDI），12-month severity with the Quick Inventory of Depressive Symptomatology Self-Report（QIDS-SR），theSheehan Disability Scale（SDS），and the WHO disability assessment scale（WHO-DAS）. Clinical reinterviews used the Structured Clinical Interview for DSM-IV.

Results： The prevalence of CIDI MDD for lifetime was 16.2%（95% confidence interval ［CI］，15.1-17.3）（32.6-35.1 million US adults）and for 12-month was 6.6%（95% CI； 5.9-7.3）（13.1-14.2 million US adults）. Virtually all CIDI 12-month cases were independently classified as clinically significant using the QIDS-SR，with 10.4% mild，38.6% moderate，38.0% severe，and 12.9% very severe. Mean episode duration was 16 weeks（95% Cl，15.1-17.3）. Role impairment as measured by SIDS was substantial as indicated by 59.3% of 12-month cases with severe or very severe role impairment. Most lifetime（72.1%）and 12-month（78.5%）cases had comorbid CIDI/DSM-IV disorders，with MDD only rarely primary. Although 51.6%（95% Cl，46.1-57.2）of 12-month cases received health care treatment for MDD，treatment was adequate in only 41.9%（95% Cl，35.9-47.9）of these cases，resulting in 21.7%（95% Cl，18.1-25.2）of 12-month MDD being adequately treated. Sociodemographic correlates of treatment were far less numerous than those of prevalence.

Conclusions： Major depressive disorder is a common disorder，widely distributed in the population，and usually associated with substantial symptom severity and role impairment. While the recent increase in treatment is encouraging，inadequate treatment is a serious concern. Emphasis on screening and expansion of treatment needs to be accompanied by a parallel emphasis on treatment quality improvement.

Keywords： International Diagnostic Interview； Randomized Controlled Trial； Impulse-Control Disorders； United-tates； Primary-Care；

Psychiatric-Disorders； Mental-Disorders； Quality Improvement； Anxiety Disorders； Bipolar Disorder

来源出版物：JAMA-Journal of the Ameracan Medical Association，2003，289（23）： 3095-3105

被引频次：2881

Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale

Cox JL； Holden JM； Sagovsky，R

Abstract： The development of a 10-item self-report scale（EPDS）to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity，and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.

来源出版物：British Journal of Psychiatry，1987，150（6）： 782-786

·推荐论文摘要·

功能MRI揭示抑郁症脑结构及功能变化的应用及展望

房俊芳，王倩，王滨，等

摘要：抑郁症是由多种因素导致的心境障碍性疾病，主要表现为情绪低落，悲观，严重者甚至会有自杀倾向.有研究发现抑郁症与脑部某些神经联系减低及神经递质减少有关.随着功能MRI的发展，越来越多的人将功能MRI用于抑郁症的研究，以期阐明其发病机制.与传统的成像方式相比，它能反应脑白质微结构的变化并将相应脑区的功能状态影像化，有利于更加直观地分析研究脑结构与功能之间的关系.

关键词：抑郁症；脑疾病；磁共振成像；扩散张量成像；磁共振波谱学

来源出版物：磁共振成像，2015，6（1）： 52-57联系邮箱：王滨，binwang001@aliyun.com

老年脑卒中后抑郁与血管事件的相关性分析

梁晨，陈文权，高社荣

摘要：目的：探讨老年脑卒中后抑郁（PSD）的相关因素及PSD与血管事件发生的相关性.方法：选择2011年7月—2014年4月兵团七师医院神经内科收治的326例老年脑卒中患者为研究对象，收集患者临床资料，根据汉密尔顿抑郁量表进行评分，分为PSD组（83例）和非PSD组（243例），出院随访至2014年7月，分析老年PSD发病相关因素及其与血管事件的相关性.结果：PSD组高血压、糖尿病、冠心病患病率高于非PSD组（χ2=6.374、6.481、7.096，P＜0.05），PSD组NIHSS评分高于非PSD组（u=3724，P＜0.001）.PSD组血管事件发生率为16.9%（14/83），高于非PSD组的8.2%（20/243）（χ2=4.374，P＜0.05）.Logistic回归分析显示，糖尿病［OR=2.961，95%CI（1.192，7.358），P＜0.05］、血脂［OR=2.383，95%CI（1.134，5.007），P＜0.05］和PSD［OR=4.592，95%CI（1.823，11.567），P＜0.05］是血管事件发生的危险因素.结论：老年脑卒中患者合并高血压、糖尿病、冠心病或神经功能缺损严重易并发PSD，糖尿病、血脂、PSD是随访期发生血管事件的独立危险因素.

关键词：卒中；抑郁症；血管疾病；老年人

来源出版物：中国全科医学，2015，18（5）： 513-516联系邮箱：梁晨，liangc@ sina. cn

失眠与抑郁关系2008—2013年研究进展及存在问题

张继辉，刘亚平，潘集阳

摘要：失眠障碍和抑郁症是成人和儿童最常见的精神障碍之一.以前的观点认为，失眠症状是抑郁症的一个常见伴随症状，会随着抑郁症的缓解而消失.但逐渐积累的证据显示，失眠症状不仅是抑郁症起病及复发的危险因素，也是抑郁症治疗后的残留症状.最新的《精神障碍诊断与统计手册第5版》和《睡眠障碍国际分类第3版》将失眠障碍看作是与其他精神障碍共病的状态，这将对未来失眠症的诊疗和临床研究产生重要的影响.本文主要就2008-2013年关于失眠（障碍或症状）和抑郁症的研究进展，讨论失眠与抑郁症在疾病层面及症状层面上的关系.

关键词：失眠；抑郁症；共病；综述

来源出版物：中国心理卫生杂志，2015，29（2）： 81-86联系邮箱：张继辉，jihui. zhang@ cuhk. edu. hk.

抑郁症的脑网络失调：来自图论分析的证据

刘威，李海江，邱江

摘要：以脑成像数据为支撑，基于图论的复杂脑网络分析实现了在大尺度上对于大脑的整体定量分析，克服了传统抑郁症病理改变研究仅关注少数几个脑区的缺点.本文主要总结了：（1）基于图论的脑网络分析的概念；（2）基于图论的抑郁症研究现状；（3）以往传统研究的不足，抑郁症脑网络研究的当前总结和未来展望.总体来说：抑郁症病人脑网络的小世界属性依旧存在，但在节点指标上存在明显的异常，且随疾病发展呈线性变化，整个网络趋向于随机化.区域性的异常主要存在于默认网络和前额叶-边缘系统环路.未来研究中，任务状态下的脑网络构建和“最小生长树”技术的应用可能会为抑郁症病人的脑网络异常提供更多的信息.

关键词：抑郁症；复杂脑网络；图论；脑连接组

来源出版物：心理科学进展，2015，23（1）： 85-92联系邮箱：邱江，qiuj318@swu.edu.cn

针刺联合西药治疗轻中度抑郁症患者88例临床观察

马学红，杨秀岩，许珂，等

摘要：目的：通过采用基于患者报告临床结局的方式观察针刺联合西药抗抑郁的疗效.方法：将88例轻、中度抑郁症患者随机分为电针组28例，手针组25例，药物组35例.药物组患者给予盐酸帕罗西汀片，治疗第1、2天每日10 mg，每日1次，从第3天开始剂量增加到每日20 mg，每日1次，共服用6周.手针组在药物组基础上配合针刺治疗，主穴：百会、印堂，基本配穴：风府、风池（双侧）、大椎、内关（双侧）、三阴交（双侧）；电针组在药物组基础上配合电针治疗，选穴同手针组，以百会和印堂、双侧风池连接于电针仪正负极，刺激频率选2/15Hz疏密交替波.手针组和电针组均隔天治疗1次，每次针刺30 min，1周治疗3次，疗程6周.观察各组治疗前后汉密尔顿抑郁量表17项（HAMD-17）、基于患者报告的症状量表（MYMOP）评分变化情况，治疗后评价临床疗效.结果：电针组临床疗效总有效率为89.28%、手针组为92.00%、药物组为85.71%，电针组和手针组优于药物组（P＜0.05）.各组患者治疗后MYMOP各项评分与本组治疗前比较差异均有统计学意义（P＜0.05），并且电针组和手针组各项评分明显低于药物组（P＜0.05），而电针组和手针组各项评分比较差异无统计学意义（P＞0.05）.结论针刺联合西药可以显著降低轻、中度抑郁症患者HAMD-17及MYMOP评分，改善主要症状、总体健康状况和活动情况，优于单纯西药治疗.

关键词：抑郁症；针刺疗法；电针疗法；汉密尔顿抑郁量表17项；患者报告的症状量表

来源出版物：中医杂志，2014，55（6）： 493-496联系邮箱：图娅，tuyab@263.net

肝郁脾虚抑郁症研究进展

董洪坦，韩刚，朱晓晨，等

摘要：肝郁脾虚证是抑郁症常见证型之一，常由肝气郁结证转化而来.目前，对于抑郁症肝郁脾虚证的基础研究，一般认为，肝郁脾虚时，机体存在神经-内分泌-免疫系统失调、脑肠轴异常、脑电生理功能紊乱.抑郁症肝郁脾虚证临床治疗的效应机制可能与神经-内分泌-免疫网络、信号通路、基因表达关系密切.该文将近十年有关抑郁症肝郁脾虚证临床流行病学调查、证候标准化研究、病理生理学基础、临床效应及效应机制方面的研究成果及文献进行综述，并对研究中存在的一些问题进行讨论，提出今后的研究思路与建议.

关键词：抑郁症；肝郁脾虚；综述

来源出版物：环球中医药，2014，7（2）： 146-150联系邮箱：郭蓉娟，dfguorongjuan@163.com

大型综合医院住院患者自杀引发的思考

胡德英，刘义兰，邓先锋，等

摘要：回顾性分析某大型综合医院护理安全不良事件上报数据中的21例住院患者自杀的详细资料，并访谈曾经发生患者自杀事件的病房护士长或当事人，发现自杀高危患者具有抑郁症病史或家族史、有自杀病史或家族史、治疗效果不好的癌症患者、久治不愈的重病患者等特征；认知因素、缺乏合适的心理评估、医院管理存在薄弱环节等是影响患者自杀的重要因素.建议建立患者自杀评估及心理评估体系、加强患者心理健康教育与医院管理等措施，以及时发现自杀患者，防止与减少患者自杀事件的发生.

关键词：住院患者；自杀；心理护理；心理评估；抑郁症

来源出版物：护理学杂志，2014，29（7）： 61-63联系邮箱：胡德英，hude-ying2006@126.com

成都市中心城区社区中老年居民抑郁症筛查及其危险因素研究

王伟文，廖晓阳，杨职艺，等

摘要：目的：调查成都市中心城区社区中老年居民抑郁症患病状况并探讨相关危险因素.方法：采取多阶段整群抽样方法选取成都市2个城区社区，使用社区流行病学调查常用的患者健康问卷（PHQ-2）抑郁筛查量表和自行设计的一般资料调查问卷，对被选社区居住2年以上的35～70岁中老年居民进行入户面对面调查.采用SPSS 18.0软件计算患病率并使用logistic回归模型对主要危险因素进行多因素分析.结果：共调查城区居民1015人，其中女性616人，男性399人，年龄58.90±9.48岁.35～70岁城区居民抑郁症患病率为4.33%（44/1015），其中男性患病率（2.95%，10/339）低于女性（5.52%，34/616）；人口标化后男、女患病率分别为3.41%和6.37%，且差异有统计学意义（χ2=6.021，P＜0.05）.多因素logistic回归分析结果显示：城区45～55岁人群较65岁以上人群患抑郁症风险增加［OR=3.465，95%CI（1.470，8.173）］；已婚较离婚人群患抑郁症风险降低［OR=0.174，95%CI（0.040，0.747）］；家庭收入每增加500元，其患抑郁症风险降低27.6%［OR=0.724，95%CI（0.583，0.898）］.结论：成都市城区社区中老年居民女性抑郁症患病率高于男性，中年、离婚和低收入居民是罹患抑郁症的主要危险因素.

关键词：抑郁症；城区社区；中老年居民；PHQ-2抑郁筛查量表；流行病学调查；危险因素

来源出版物：中国循证医学杂志，2014，14（1）： 21-24联系邮箱：王伟文，wangweiwen@sohu.com

昆明小鼠强迫游泳实验与悬尾实验抑郁模型相关性

孙世光，刘健，鹿岩，等

摘要：目的：探讨强迫游泳实验（FST）和悬尾实验（TST）作为昆明小鼠抑郁动物模型的相关性.方法：成年雄性昆明小鼠先后进行TST和FST，摄像系统分别记录6 min内的行为变化，实验间隔1周，实验参数有不动状态潜伏期和不动状态持续时间百分率；采用因子分析、聚类分析、相关分析、一致性检验和生存分析等多种统计方法进行数据处理.结果：①因子分析提示，FST与TST参数分别反映了FST与TST 2种不同抑郁模型维度.②聚类分析提示，不动状态潜伏期参数反映了抗抑郁状态，不动状态持续时间百分率反映了抑郁样绝望行为；经过适当数据转换后，FST与TST参数分别反映了FST与TST 2种不同抑郁模型维度.③相关分析结果提示，FST与TST参数组内具有较好相关性，而组间不动状态潜伏期参数相关性尚可.④一致性检验ICC统计参数提示，FST与TST参数评价抑郁样绝望行为一致性均较差；Kappa统计参数提示，不动状态潜伏期可作为FST与TST评价抑郁样绝望行为一致性的稳定参数.⑤生存分析提示，FST与TST的不动状态潜伏期参数半数生存期差异有统计学意义，即FST与TST实验操作对实验动物首次产生抑郁样绝望行为的效力不同，且FST＜TST.结论：FST与TST参数反映了2种不同抑郁模型维度；不动状态潜伏期是FST与TST评价抑郁样绝望行为一致性及首次产生抑郁样绝望行为效力的稳定参数；FST与TST联合进行抗抑郁药物评价时，应注意动物模型异质性问题.

关键词：抑郁症；动物模型；强迫游泳实验；悬尾实验；相关性

来源出版物：中国药理学与毒理学杂志，2014，28（1）： 107-112联系邮箱：孙世光，S.G.SUN@hotmail.com

团体心理治疗对抑郁症患者疗效及生活质量的影响

宋丽，余学，张慧芳

摘要：目的：探讨团体心理治疗对抑郁症患者的疗效及生活质量的影响.方法：将符合CCMD-3抑郁症诊断标准的122例住院患者，随机分成研究组（60例）和对照组（62例），研究组给予团体心理治疗联合药物治疗，对照组仅接受药物治疗，观察8周.采用汉密尔顿抑郁量表（HAMD）和世界卫生组织生活质量量表（WHO.QOL-100）于治疗前和治疗后8周进行量表评定.结果：治疗后8周末，两组HAMD总分均显著下降，但研究组较对照组下降更明显（t=4.82，P＜0.01）；两组的生活质量均有改善，但研究组在生活质量总评（t=2.94，P＜0.01）、心理领域（t=2.44，P＜0.05）、独立性领域（t=2.98，P＜0.01）及社会关系领域（t=2.25，P＜0.05）的改善显著好于对照组.结论：团体心理治疗能有效改善抑郁症的精神症状，提高其生活质量，有利于患者重返社会.

关键词：团体心理治疗；抑郁症；疗效；生活质量

来源出版物：中国健康心理学杂志，2013，21（1）： 51-53联系邮箱：宋丽，ZMDduqihang@126.com

音乐电针对慢性应激抑郁模型大鼠海马单胺类神经递质表达的调节作用

唐银杉，余仁锋，纪倩，等

摘要：目的：观察音乐电针对慢性应激抑郁模型大鼠海马单胺类神经递质五羟色胺（5-HT）、多巴胺（DA）、去甲肾上腺素（NE）表达的影响，探讨音乐电针治疗抑郁症的作用机制.方法：SD大鼠随机分为4组：空白组、模型组、氟西汀组、音乐电针组，除空白组外，其余均采用慢性应激结合孤养的方式造模.采用旷场实验、糖水消耗量检测和体重测量进行行为学评价；采用放射免疫法检测大鼠海马5-HT、NE、DA的表达.结果与空白组比较，模型组大鼠水平穿越格数、竖立次数、糖水消耗量、体重明显降低（P＜0.01）；与模型组比较，氟西汀组、音乐电针组水平穿越格数、竖立次数、糖水消耗量、体重均明显升高（P＜0.05）.与空白组相比，模型组大鼠海马组织5-HT、DA、NE 的含量明显降低（P＜0.01）；与模型组相比，氟西汀组大鼠海马组织的5-HT、DA、NE 的含量升高（P＜0.05）；音乐电针组大鼠海马组织的5-HT、DA、NE 的含量升高（P＜0.01、P＜0.05）.与氟西汀组比较，音乐电针组大鼠海马组织的5-HT的含量增加，有显著性差异（P＜0.05）.结论：音乐电针可以改善慢性应激抑郁大鼠的行为学症状，具有一定的抗抑郁作用；它能提高慢性应激模型大鼠中枢单胺类神经递质5-HT、DA、NE的水平，这可能是音乐电针发挥抗抑郁治疗作用的途径之一.

关键词：音乐电针；慢性应激；抑郁症；五羟色胺；多巴胺；去甲肾上腺素；大鼠

来源出版物：北京中医药大学学报，2013，36（4）： 263-267联系邮箱：李志刚，lizhigang620@126.com

Anxiety，Depression，and Cigarette Smoking： A Transdiagnostic Vulnerability Framework to Understanding Emotion-Smoking Comorbidity

Leventhal AM； Zvolensky MJ

Abstract： Research into the comorbidity between emotional psychopathology and cigarette smoking has often focused upon anxiety and depression's manifest symptoms and syndromes，with limited theoretical and clinical advancement. This article presents a novel framework to understanding emotion-smoking comorbidity. We propose that transdiagnostic emotional vulnerabilities-core biobehavioral traits reflecting maladaptive responses to emotional states that underpin multiple types of emotional psychopathology-link various anxiety and depressive psychopathologies to smoking. This framework is applied in a review and synthesis of the empirical literature on 3 transdiagnostic emotional vulnerabilities implicated in smoking：（a）anhedonia（Anh； diminished pleasure/interest in response to rewards），（b）anxiety sensitivity（AS； fear of anxiety-related sensations），and（c）distress tolerance（DT； ability to withstand distressing states）. We conclude that Anh，AS，and DT collectively（a）underpin multiple emotional psychopathologies，（b）amplify smoking's anticipated and actual affect-enhancing properties and other mechanisms underlying smoking，（c）promote progression across the smoking trajectory（i.e.，initiation，escalation/progression，maintenance，cessation/relapse），and（d）are promising targets for smoking intervention. After existing gaps are identified，an integrative model of transdiagnostic processes linking emotional psychopathology to smoking is proposed. The model's key premise is that Anh amplifies smoking's anticipated and actual pleasure-enhancing effects，AS amplifies smoking's anxiolytic effects，and poor DT amplifies smoking's distress terminating effects. Collectively，these processes augment the reinforcing properties of smoking for individuals with emotional psychopathology to heighten risk of smoking initiation，progression，maintenance，cessation avoidance，and relapse. We conclude by drawing clinical and scientific implications from this framework that may generalize to other comorbidities.

Keywords： anxiety； depression； smoking； comorbidity； nicotine dependence

来源出版物：Psychological Bulletin，2015，141（1）： 176-212联系邮箱：Leventhal AM； adam.leventhal@usc.edu

Treatment-Resistant Bipolar Depression： A Randomized Controlled Trial of Electroconvulsive Therapy Versus Algorithm-Based Pharmacological Treatment

Schoeyen HK； Kessler U； Andreassen OA； et al.

Abstract： Objective： Electroconvulsive therapy（ECT）is regarded by many clinicians as the most effective treatment for treatment-resistant bipolar depression，but no randomized controlled trials have been conducted，to the authors' knowledge. They compared efficacy measures of ECT and algorithm-based pharmacological treatment in treatment-resistant bipolar depression.

Method： This multicenter，randomized controlled trial was carried out at seven acute-care psychiatric inpatient clinics throughout Norway and included 73 bipolar disorder patients with treatment-resistant depression. The patients were randomly assigned to receive either ECT or algorithm-based pharmacological treatment. ECT included three sessions per week for up to 6 weeks，right unilateral placement of stimulus electrodes，and brief pulse stimulation.

Results： Linear mixed-effects modeling analysis revealed that ECT was significantly more effective than algorithm-based pharmacological treatment. The mean scores at the end of the 6-week treatment period were lower for the ECT group than for the pharmacological treatment group： by 6.6 points on the Montgomery-Asberg Depression Rating Scale（SE=2.05，95% CI=2.5-10.6），by 9.4 points on the 30-item version of the Inventory of Depressive Symptomatology-Clinician-Rated（SE=2.49，95% CI=4.6-14.3），and by 0.7 points on the Clinical Global Impression for Bipolar Disorder（SE=0.31，95% CI=0.13-1.36）. The response rate was significantly higher in the ECT group than in the group that received algorithm-based pharmacological treatment（73.9% versus 35.0%），but the remission rate did not differ between the groups（34.8% versus 30.0%）.

Conclusion： Remission rates remained modest regardless of treatment choice for this challenging clinical condition.

Keywords： rating-scale；disorder；metaanalysis；unipolar；efficacy；ECT；recommendations；guidelines；inpatients；episode

来源出版物：American Journal of Psychiatry，2015，172（1）： 41-51联系邮箱：Schoeyen HK； hsc@sus.no

Efficacy and safety of deep transcranial magnetic stimulation for major depression：a prospective multicenter randomized controlled trial

Levkovitz Y； Isserles M； Padberg F； et al.

Abstract： Major depressive disorder（MDD）is a prevalent and disabling condition，and many patients do not respond to available treatments. Deep transcranial magnetic stimulation（dTMS）is a new technology allowing non-surgical stimulation of relatively deep brain areas. This is the first double-blind randomized controlled multicenter study evaluating the efficacy and safety of dTMS in MDD. We recruited 212 MDD outpatients，aged 22-68 years，who had either failed one to four antidepressant trials or not tolerated at least two antidepressant treatments during the current episode. They were randomly assigned to monotherapy with active or sham dTMS. Twenty sessions of dTMS（18 Hz over the prefrontal cortex）were applied during 4 weeks acutely，and then biweekly for 12 weeks. Primary andsecondary efficacy endpoints were the change in the Hamilton Depression Rating Scale（HDRS-21）score and response/remission rates at week 5，respectively. dTMS induced a 6.39 point improvement in HDRS-21 scores，while a 3.28 point improvement was observed in the sham group（p=0.008），resulting in a 0.76 effect size. Response and remission rates were higher in the dTMS than in the sham group（response： 38.4 vs. 21.4%，p=0.013； remission： 32.6 vs. 14.6%，p=0.005）. These differences between active and sham treatment were stable during the 12-week maintenance phase. dTMS was associated with few and minor side effects apart from one seizure in a patient where a protocol violation occurred. These results suggest that dTMS constitutes a novel intervention in MDD，which is efficacious and safe in patients not responding to antidepressant medications，and whose effect remains stable over 3 months of maintenance treatment.

Keywords： deep transcranial magnetic stimulation； major depressive disorder； treatment resistance； response； remission； maintenance treatment

来源出版物：World Psychiatry，2015，14（1）： 64-73

Metabotropic glutamate receptor 3 activation is required for long-term depression in medial prefrontal cortex and fear extinction

Walker AG； Wenthur CJ； Xiang ZX； et al.

Abstract： Clinical studies have revealed that genetic variations in metabotropic glutamate receptor 3（mGlu3）affect performance on cognitive tasks dependent upon the prefrontal cortex（PFC）and may be linked to psychiatric conditions such as schizophrenia，bipolar disorder，and addiction. We have performed a series of studies aimed at understanding how mGlu3 influences PFC function and cognitive behaviors. In the present study，we found that activation of mGlu3 can induce long-term depression in the mouse medial PFC（mPFC）in vitro. Furthermore，in vivo administration of a selective mGlu3 negative allosteric modulator impaired learning in the mPFC-dependent fear extinction task. The results of these studies implicate mGlu3 as a major regulator of PFC function and cognition. Additionally，potentiators of mGlu3 may be useful in alleviating prefrontal impairments associated with several CNS disorders.

Keywords： GRM3； medial prefrontal cortex； fear extinction； long-term depression； group II mGlu receptors

来源出版物：Proceedings of the National Academy of Sciences of the United States of America，2015，112（4）： 1196-1201

联系邮箱：Conn，PJ； jeff.conn@vanderbilt.edu

Enhancing Depression Mechanisms in Midbrain Dopamine Neurons Achieves Homeostatic Resilience

Friedman AK； Walsh JJ； Juarez B； et al.

Abstract： Typical therapies try to reverse pathogenic mechanisms. Here，we describe treatment effects achieved by enhancing depression-causing mechanisms in ventral tegmental area（VTA）dopamine（DA）neurons. In a social defeat stress model of depression，depressed（susceptible）mice display hyperactivity of VTA DA neurons，caused by an up-regulated hyperpolarization-activated current（I-h）. Mice resilient to social defeat stress，however，exhibit stable normal firing of these neurons. Unexpectedly，resilient mice had an even larger Ih，which was observed in parallel with increased potassium（K+）channel currents. Experimentally further enhancing Ih or optogenetically increasing the hyperactivity of VTA DA neurons in susceptible mice completely reversed depression-related behaviors，an antidepressant effect achieved through resilience-like，projection-specific homeostatic plasticity. These results indicate a potential therapeutic path of promoting natural resilience for depression treatment.

Keywords： ventral tegmental area；social defeat stress；reward circuit；I-H；channels；susceptibility；inhibition；BDNF

来源出版物：Science，2014，344（6181）： 313-319联系邮箱：Han MH； ming-hu.han@mssm.edu

The association between low vitamin D and depressive disorders

Milaneschi Y； Hoogendijk W； Lips P； et al.

Abstract： It has been hypothesized that hypovitaminosis D is associated with depression but epidemiological evidence is limited. We investigated the association between depressive disorders and related clinical characteristics with blood concentrations of 25-hydroxyvitamin D ［25（OH）D］ in a large cohort. The sample consisted of participants（aged 18-65 years）from the Netherlands Study of Depression and Anxiety（NESDA）with a current（N=1102）or remitted（N=790）depressive disorder（major depressive disorder，dysthymia）defined according to DSM-IV criteria，and healthy controls（N=494）. Serum levels of 25（OH）D measured and analyzed in multivariate analyses adjusting for sociodemographics，sunlight，urbanization，lifestyle and health. Of the sample，33.6% had deficient or insufficient serum 25（OH）D（＜50 nmol l-1）. As compared with controls，lower 25（OH）D levels were found in participants with current depression（P=0.001，Cohen's d=0.21），particularly in those with the most severe symptoms（P=0.001，Cohen's d=0.44）. In currently depressed persons，25（OH）D was inversely associated with symptom severity（beta=-0.19，s.e. -0.07，P=0.003）suggesting a dose-response gradient，and with risk（relative risk =0.90，95% confidence interval =0.82-0.99，P=0.03）of having a depressive disorders at 2-year follow-up. This large cohort study indicates that low levels of 25（OH）D were associated to the presence and severity of depressive disorder suggesting that hypovitaminosis D may represent an underlying biological vulnerability for depression. Future studies should elucidate whether-the highly prevalent-hypovitaminosis D could be cost-effectively treated as part of preventive or treatment interventions for depression.

Keywords： vitamin D； parathyroid hormone； depressive disorder

来源出版物：Molecular Psychiatry，2014，19（4）： 444-451联系邮箱：Milaneschi Y ； y.milaneschi@ggzingeest.nl

From Stress to Inflammation and Major Depressive Disorder：A Social Signal Transduction Theory of Depression

Slavich GM； Irwin MR

Abstract： Major life stressors，especially those involving interpersonal stress and social rejection，are among the strongest proximal risk factors for depression. In this review，we propose a biologically plausible，multilevel theory that describes neural，physiologic，molecular，and genomic mechanisms that link experiences of social-environmental stress with internal biological processes that drive depression pathogenesis. Central to this social signal transduction theory of depression is the hypothesis that experiences of social threat and adversity up-regulate components of the immune system involved in inflammation. The key mediators of this response，called proinflammatory cytokines，can in turn elicit profound changes in behavior，which include the initiation of depressive symptoms such as sad mood，anhedonia，fatigue，psychomotor retardation，and social-behavioral withdrawal. This highly conserved biological response to adversity is critical for survival during times of actual physical threat or injury. However，this response can also be activated by modern-day social，symbolic，or imagined threats，leading to an increasingly proinflammatory phenotype that may be a key phenomenon driving depression pathogenesis and recurrence，as well as the overlap of depression with several somatic conditions including asthma，rheumatoid arthritis，chronic pain，metabolic syndrome，cardiovascular disease，obesity，and neurodegeneration. Insights from this theory may thus shed light on several important questions including how depression develops，why it frequently recurs，why it is strongly predicted by early life stress，and why it often co-occurs with symptoms of anxiety and with certain physical disease conditions. This work may also suggest new opportunities for preventing and treating depression by targeting inflammation.

Keywords： early life stress； social threat； cytokines； mechanisms； disease

来源出版物：Psychological Bulletin，2014，140（3）： 774-815联系邮箱：Slavich GM ； gslavich@mednet.ucla.edu

Rapid regulation of depression-related behaviours by control of midbrain dopamine neurons

Chaudhury D； Walsh JJ； Friedman AK； et al.

Abstract： Ventral tegmental area（VTA）dopamine neurons in the brain's reward circuit have a crucial role in mediating stress responses（1-4），including determining susceptibility versus resilience to social-stress-induced behavioural abnormalities（5）. VTA dopamine neurons show two in vivo patterns of firing： low frequency tonic firing and high frequency phasic firing（6-8）. Phasic firing of the neurons，which is well known to encode reward signals（6，7，9），is upregulated by repeated social-defeat stress，a highly validated mouse model of depression（5，8，10-13）. Surprisingly，this pathophysiological effect is seen in susceptible mice only，with no apparent change in firing rate in resilient individuals（5，8）. However，direct evidence-in real time-linking dopamine neuron phasic firing in promoting the susceptible（depression-like）phenotype is lacking. Here we took advantage of the temporal precision and cell-type and projection-pathway specificity of optogenetics to show that enhanced phasic firing of these neurons mediates susceptibility to social-defeat stress in freely behaving mice. We show that optogenetic induction of phasic，but not tonic，firing in VTA dopamine neurons of mice undergoing a subthreshold social-defeat paradigm rapidly induced a susceptible phenotype as measured by social avoidance and decreased sucrose preference. Optogenetic phasic stimulation of these neurons also quickly induced a susceptible phenotype in previously resilient mice that had been subjected to repeated social-defeat stress. Furthermore，we show differences in projection-pathway specificity in promoting stress susceptibility： phasic activation of VTA neurons projecting to the nucleus accumbens（NAc），but not to the medial prefrontal cortex（mPFC），induced susceptibility to social-defeat stress. Conversely，optogenetic inhibition of the VTA-NAc projection induced resilience，whereas inhibition of the VTA-mPFC projection promoted susceptibility. Overall，these studies reveal novel firing-pattern-and neural-circuitspecific mechanisms of depression.

Keywords： ventral tegmental area； social defeat stress； antidepressant action； reward circuit； IN-VIVO； susceptibility； stimulation；inhibition； expression； responses

来源出版物：Nature，2013，493（7433）： 532-538联系邮箱：Han MH； ming-hu.han@mssm.edu

Dopamine neurons modulate neural encoding and expression of depression-related behaviour

Tye KM； Mirzabeko，JJ； Warde，MR； et al.

Abstract： Major depression is characterized by diverse debilitating symptoms that include hopelessness and anhedonia（1）. Dopamine neurons involved in reward and motivation（2-9）are among many neural populations that have been hypothesized to be relevant（10），and certain antidepressant treatments，including medications and brain stimulation therapies，can influence the complex dopamine system. Until now it has not been possible to test this hypothesis directly，even in animal models，as existing therapeutic interventions are unable to specifically target dopamine neurons. Here we investigated directly the causal contributions of defined dopamine neurons to multidimensional depression-like phenotypes induced by chronic mild stress，by integrating behavioural，pharmacological，optogenetic andelectrophysiological methods in freely moving rodents. We found that bidirectional control（inhibition or excitation）of specified midbrain dopamine neurons immediately and bidirectionally modulates（induces or relieves）multiple independent depression symptoms caused by chronic stress. By probing the circuit implementation of these effects，we observed that optogenetic recruitment of these dopamine neurons potently alters the neural encoding of depression-related behaviours in the downstream nucleus accumbens of freely moving rodents，suggesting that processes affecting depression symptoms may involve alterations in the neural encoding of action in limbic circuitry.

Keywords： stress-induced anhedonia； ventral tegmental area； social defeat； animal-model； aversive stimuli； reward circuit； gaba neurons；susceptibility； mice； inhibition

来源出版物：Nature，2013，493（7433）： 537-541联系邮箱：Tye KM ； kaytye@mit.edu

The neuroprogressive nature of major depressive disorder： pathways to disease evolution and resistance，and therapeutic implications

Moylan S； Maes M； Wray NR； et al.

Abstract： In some patients with major depressive disorder（MDD），individual illness characteristics appear consistent with those of a neuroprogressive illness. Features of neuroprogression include poorer symptomatic，treatment and functional outcomes in patients with earlier disease onset and increased number and length of depressive episodes. In such patients，longer and more frequent depressive episodes appear to increase vulnerability for further episodes，precipitating an accelerating and progressive illness course leading to functional decline. Evidence from clinical，biochemical and neuroimaging studies appear to support this model and are informing novel therapeutic approaches. This paper reviews current knowledge of the neuroprogressive processes that may occur in MDD，including structural brain consequences and potential molecular mechanisms including the role of neurotransmitter systems，inflammatory，oxidative and nitrosative stress pathways，neurotrophins and regulation of neurogenesis，cortisol and the hypothalamic-pituitary-adrenal axis modulation，mitochondrial dysfunction and epigenetic and dietary influences. Evidence-based novel treatments informed by this knowledge are discussed.

Keywords： cytokines； depression； inflammation； neuroprogression； nitrosative stress； oxidative stress

来源出版物：Molecular Psychiatry，2013，18（5）： 595-606联系邮箱：Moylan S； steven.moylan@deakin.edu.au

Burden of Depressive Disorders by Country，Sex，Age，and Year： Findings from the Global Burden of Disease Study 2010

Ferrari AJ； Charlson FJ； Norman RE； et al.

Abstract： Background： Depressive disorders were a leading cause of burden in the Global Burden of Disease（GBD）1990 and 2000 studies. Here，we analyze the burden of depressive disorders in GBD 2010 and present severity proportions，burden by country，region，age，sex，and year，as well as burden of depressive disorders as a risk factor for suicide and ischemic heart disease.

Methods and Findings： Burden was calculated for major depressive disorder（MDD）and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability（YLDs）and disability adjusted life years（DALYs）. Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders. Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2%（5.9%-10.8%）of global YLDs and dysthymia for 1.4%（0.9%-2.0%）. Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5%（1.9%-3.2%）of global DALYs and dysthymia for 0.5%（0.3%-0.6%）. There was more regional variation in burden for MDD than for dysthymia； with higher estimates in females，and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010，this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0%（2.2%-3.8%）to 3.8%（3.0%-4.7%）of global DALYs.

Conclusions： GBD 2010 identified depressive disorders as a leading cause of burden. MDD was also a contributor of burden allocated to suicide and ischemic heart disease. These findings emphasize the importance of including depressive disorders as a public-health priority and implementing cost-effective interventions to reduce its burden.

Keywords： systematic analysis； lifetime prevalence； major depression； 21 regions； disability； health； injuries； recall； common

来源出版物：Plos Medicine，2013，10（11）： 331-343联系邮箱：Ferrari AJ； alize_ferrari@qcmhr.uq.edu.au

（责任编辑王帅帅王微（实习生））

The appearance of yet another rating scale for measuring symptoms of mental disorder may seem unnecessary，since there are so many already in existence and many of them have been extensively used. Unfortunately，it cannot be said that per-fection has been achieved，and indeed，there is considerable room for improvement.

Psychiatric status rating scales； anxiety disorders； depressive disorders

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A rating scale for depression

Hamilton M