Positive and negative valence systems in major depression have distinct clinical features, response to antidepressants, and relationships with immunomarkers.
Positive and negative valence systems in major depression have distinct clinical features, response to antidepressants, and relationships with immunomarkers.
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抑郁症的正、负效价系统具有不同的临床特征、对抗抑郁药的反应以及与免疫标志物的关系。
DOI：
10.1002/da.23006
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发表时间：
2020-08
影响因子：
7.4
通讯作者：
Trivedi, Madhukar H.
中科院分区：
文献类型：
--
作者：
Medeiros, Gustavo C.;Rush, A. John;Jha, Manish;Carmody, Thomas;Furman, Jennifer L.;Czysz, Andrew H.;Trombello, Joseph M.;Cooper, Crystal M.;Trivedi, Madhukar H.
重度抑郁障碍（MDD）的异质性已经得到了很好的认识，但尚未得到很好的理解。核心抑郁特征是奖励和情绪症状，分别反映了正效价和负效价系统的功能障碍。本研究评估PV和NV系统（基于选定的症状）是否与成年重度抑郁症患者的不同临床特征、抗抑郁反应和免疫标志物水平相关。这些分析使用的数据来自联合用药增强抑郁预后（CO-MED）研究（N=665；免疫标记物N= 166）。PV和NV症状评分是从临床评定的30项抑郁症状量表中提取的。进行相关分析。PV和NV症状评分与不同的临床特征显著相关。根据7项认知和身体功能问卷，PV症状（动机受损、能量受损和快感缺乏）与女性（p< 0.001）、年龄（p= 0.012）和较高的认知和身体障碍（p< 0.001）独立相关。相反，NV症状（焦虑和人际敏感）与年龄较小（p= 0.013）、更多的焦虑共病（广泛性焦虑症p= 0.001，社交恐惧症p= 0.002）和其他常见的非标准症状（p< 0.001）独立相关。总体而言，PV症状比NV症状对抗抑郁药更敏感（p< 0.0001; Cohen’s d=0.455）。PV症状评分与3种促炎因子和1种抗炎因子浓度呈正相关。相反，NV症状评分仅与一种促炎免疫标志物负相关。PV和NV系统功能似乎反映在与其他临床特征、治疗结果和免疫功能不同的临床症状中。
Heterogeneity in major depressive disorder (MDD) is well recognized but not well understood. Core depressive features are reward and emotional symptoms, which reflect dysfunctions in the positive valence (PV) and negative valence (NV) systems, respectively. This study assessed whether PV and NV systems (based on selected symptoms) were associated with different clinical features, antidepressant response and levels of immunomarkers in adults with MDD. These analyses used data from the Combining Medications to Enhance Depression Outcomes (CO-MED) study (N=665; n=166 for immunomarkers). PV and NV symptom scores were extracted from the clinician-rated 30-item Inventory of Depressive Symptomatology. Correlational analyses were conducted. PV and NV symptom scores were substantially associated with different clinical features. PV symptoms (impaired motivation, impaired energy and anhedonia) were independently associated with female gender (p<.001), older age (p=.012), and higher cognitive and physical impairment (p<.001) according to the 7-item Cognitive and Physical Functioning Questionnaire. Conversely, NV symptoms (anxiety and interpersonal sensitivity) were independently associated with younger age (p=.013), more anxious comorbidities (p=.001 for GAD, p=.002 for social phobia) and other commonly associated non criterion symptoms (p<.001). Overall, PV symptoms were more responsive to antidepressants than NV symptoms (p<.0001; Cohen’s d=0.455). A PV symptom score was positively correlated with the concentration of three pro-inflammatory and one anti-inflammatory factors. In contrast, a NV symptom score was negatively associated with only one pro-inflammatory immunomarker. PV and NV system function appears to be reflected in selected clinical symptoms that differentially relate to other clinical features, treatment outcomes and immunological function.
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