The ties that bind: maternal-infant interactions and the neural circuitry of postpartum depression.
The ties that bind: maternal-infant interactions and the neural circuitry of postpartum depression.
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联系的纽带：母婴互动和产后抑郁症的神经回路。
DOI：
10.1176/appi.ajp.2010.10081159
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Yonkers,KimberlyA
中科院分区：
文献类型：
--
作者：
Leibenluft,Ellen;Yonkers,KimberlyA
人们对产后抑郁症的病理生理学知之甚少。虽然许多(如果不是大多数)精神疾病也是如此，但在产后抑郁的情况下，尤其迫切需要进行病理生理学研究，以指导新疗法的开发，因为这种疾病不仅影响到经历这种疾病的妇女，而且还影响到她的新生儿和其他家庭成员(1)。但是，虽然产后抑郁症的病理生理学研究特别重要，但考虑到产后抑郁症的生物学和后勤复杂性，进行这些研究也非常困难。因此，摩西-科尔科等人(2)在本期期刊上的研究是对文献的一个值得欢迎的补充。作者使用功能磁共振成像(FMRI)对16名健康女性和14名未服用药物的单相抑郁症女性在分娩后12周内进行了研究。在接受扫描的同时，受试者完成了一项任务，其中包括形状和脸部匹配块，后者包括愤怒和悲伤的面孔。这项任务旨在探索两组之间杏仁核活动的差异。以前在抑郁症患者中使用类似任务的fMRI研究显示，杏仁核活动和杏仁核-内侧前额叶皮质连接异常，对消极的情绪面孔做出反应(3)。然而，这些异常的确切性质，以及它们在单相和双相抑郁中的不同程度，仍不清楚。考虑到以前的文献，摩西-科尔科等人。他们重点分析了杏仁核和内侧前额叶皮质的活动。他们的主要发现是背内侧前额叶皮质中的一组条件相互作用(该发现特别是在布罗德曼的第32区)。抑郁母亲和对照母亲都更多地激活了这一区域，而不是对形状的反应，而抑郁母亲比对照母亲更多地激活了对形状的反应，而对照母亲比抑郁母亲更多地激活了对面孔的反应。如下所述，背内侧前额叶皮质被认为是调节社会认知的重要方面。因此，值得注意的是，与对照母亲相比，抑郁的母亲在这一区域表现出对面孔的社会刺激反应的激活减少。S的发现表明，研究和治疗策略不仅要关注母亲的抑郁症，还要关注她与婴儿亲密相处的能力，这一点很重要。抑郁症的一个特征是自我关注增加，特别是以自我参照的负面思维的形式；研究表明，这种症状可能是由背内侧前额叶皮质调节的。例如，Johnson等人(4)发现，在患有严重抑郁障碍的受试者中，背内侧前额叶皮质(以及后内侧前额叶皮质)的活动、冥想和难以摆脱自我参照思维之间存在关联。大量文献表明，当受试者被要求执行“心理理论”或“心理化”任务时，背内侧前额叶皮质被激活(5)。这些任务要求受试者关注的不是自己的想法，而是他人的想法、信仰或感受。
Little is known about the pathophysiology of postpartum depression. While the same can be said for many (if not most) psychiatric illnesses, in the case of postpartum depression the need for pathophysiological studies to guide the development of novel treatments is particularly pressing because the illness affects not only the woman who experiences it, but also her newborn and other members of her family (1). But while pathophysiological studies of postpartum depression are particularly important, they are also very difficult to conduct, given the biological and logistical complexities that characterize the postpartum period. Therefore, the study by Moses-Kolko et al.(2) in this issue of the Journal is a welcome addition to the literature. The authors used functional magnetic resonance imaging (fMRI) to study 16 healthy women and 14 unmedicated unipolar depressed women within 12 weeks of giving birth. While being scanned, subjects completed a task that included shape and face matching blocks, with the latter including angry and sad faces. This task is designed to probe betweengroup differences in amygdala activity. Previous fMRI studies using similar tasks in patients with depression demonstrate abnormalities in amygdala activity and amygdala-medial prefrontal cortex connectivity in response to negatively valenced emotional faces (3). However, the precise nature of those abnormalities, and the extent to which they differ in unipolar versus bipolar depression, remains unclear. Given the previous literature, Moses-Kolko et al. focused their analysis on activity in the amygdala and the medial prefrontal cortex. Their major finding was a group-by-condition interaction in the dorsomedial prefrontal cortex (the finding was specifically in Brodmann’s area 32). While both depressed and comparison mothers activated this region more in response to faces than to shapes, depressed mothers activated more in response to shapes than comparison mothers, and comparison mothers activated more in response to faces than depressed mothers. As discussed below, the dorsomedial prefrontal cortex is known to mediate important aspects of social cognition. Therefore, it is notable that depressed mothers, relative to comparison mothers, show decreased activation in this region in response to the social stimulus of a face. Moses-Kolko et al.’s finding indicates that it is important to focus research and treatment strategies not only on a mother’s depression, but also on her ability to engage affectively with her infant. A hallmark of depression is increased self-focus, particularly in the form of self-referential negative thoughts; research suggests that this symptom may be mediated by the dorsomedial prefrontal cortex. For example, Johnson et al.(4) found associations between activity in the dorsomedial prefrontal cortex (as well as posterior medial prefrontal cortex), rumination, and difficulty disengaging from self-referential thoughts in subjects with major depressive disorder. There is an extensive body of literature indicating that the dorsomedial prefrontal cortex is activated when subjects are asked to perform “theory of mind” or “mentalizing” tasks (5). These tasks require subjects to focus not on their own thoughts but instead on the thoughts, beliefs, or feelings of other individuals.