Depression and Inflammation: Examining the Link: Inflammatory Conditions May Precipitate or Perpetuate Depression, but the Precise Relationship Is Unclear
Depression and Inflammation: Examining the Link: Inflammatory Conditions May Precipitate or Perpetuate Depression, but the Precise Relationship Is Unclear
复制标题
抑郁症和炎症：检查联系：炎症可能会引发或延续抑郁症，但确切的关系尚不清楚
作者：
Marie Almond
打喷嚏、咳嗽和喉咙痛是普通感冒的标志性症状，但让你卧床不起的是伴随而来的疲劳、注意力不集中、食欲不振、睡眠模式改变、对疼痛的感知增强和冷漠的退缩。这种“病态行为”是由疾病引起的炎症标志物引起的。(1)（2）这些症状与定义抑郁症的症状群相似。在对疾病的炎症反应中，我们看到了抑郁症的阴影，但确切的关系仍然模糊。抑郁症是正常的躯体炎症反应的一部分吗？一些研究人员认为，“病态行为”是适应性的，迫使身体进入一种收缩的模式，以便将能量集中到治疗中。(1)（3）如果抑郁症和炎症是相关的，那么抑郁症就会越过这些适应性根源，与其说是一种被迫的停顿，不如说是一种使人衰弱的退缩。也许抑郁症，或一种亚型，是炎症伴随发热、疼痛、发红和肿胀的症状。在某些情况下，抑郁症可能是潜在炎症过程的标志。(4)在我们对抑郁症病理生理学的理解中，我们看到了指向抑郁症和炎症之间关系的因素：* 抑郁症经常与许多炎性疾病共病 * 炎性生物标志物增加与重度抑郁症（MDD）相关 * 暴露于免疫调节剂可能会增加患抑郁症的风险 * 压力可以激活促炎通路 *抗抑郁药可以减少炎症反应 * 抑制炎症途径可以改善情绪。探索这些因素以及在抑郁症中发现的连接炎症和神经生物学变化的可能途径，使我们能够更近距离地观察炎症过程和抑郁症状的可能整合。疾病和抑郁症发病率患有炎症性疾病的人--自身免疫性疾病、心血管疾病、糖尿病和癌症--经常与抑郁症作斗争。近五分之一的心血管疾病患者经历MDD。(5)糖尿病诊断使患抑郁症的几率增加一倍。(6)高达70%的自身免疫性疾病患者，如类风湿性关节炎或系统性红斑狼疮，经历抑郁症。(7)在一项大规模的纵向研究中，既往有自身免疫性疾病的患者患抑郁症的风险增加了45%，有感染住院史的患者患抑郁症的风险增加了62%;在同时患有这两种疾病的患者中，患抑郁症的风险增加了一倍多。(9)几项研究表明，15%至25%的癌症患者患有抑郁症，（10）相比之下，普通人群中的这一比例为9%。(11)炎症标志物的作用表证据连接炎症和抑郁症研究样本评论Dowlati一项荟萃分析24抑郁症患者等，研究测量有显着2010（14）细胞因子浓度较高的患者与对照组相比，MDD TNF-[α]和IL-6的浓度Maes 15对照组和35血清IL-6和IL-1等，1997年住院患者与MDD.受体拮抗剂（15）血清IL-6，IL-6受体，在IL-1受体个体中更高，拮抗剂，Clara细胞抑制蛋白16，和/或sCD 8在治疗抵抗基线和抑郁5周后与对照抗抑郁治疗相比，2005年丙型肝炎感染的受试者（16例）在基线时评估了中度至重度抑郁症状，4年后评估了抑郁症状。…
Sneezing, coughing, and a sore throat are hallmark symptoms of a common cold, but what keeps you in bed are the accompanying fatigue, inattentiveness, loss of appetite, change in sleep pattern, heightened perception of pain, and apathetic withdrawal. This "sickness behavior" is induced by inflammatory markers released in response to illness. (1), (2) These symptoms are similar to the constellation of symptoms that define depression. Within the inflammatory response to illness, we see the shadow of depression, but the precise relationship remains murky. [ILLUSTRATION OMITTED] [ILLUSTRATION OMITTED] Is depression part of a normal somatic inflammatory response run amok? Some researchers have argued that "sickness behavior" is adaptive, forcing the body into a constricted pattern in order to funnel energy into healing. (1), (3) If depression and inflammation are related, depression pushes past these adaptive roots and is less a forced pause than a debilitating withdrawal. Perhaps depression, or a subtype, is a sign of inflammation along with heat, pain, redness, and swelling. In some instances, depression may be a sign of an underlying inflammatory process. (4) In our progression toward understanding depression's pathophysiology, we see factors that point to a relationship between depression and inflammation: * depression frequently is comorbid with many inflammatory illnesses * increased inflammatory biomarkers are associated with major depressive disorder (MDD) * exposure to immunomodulating agents may increase the risk of developing depression * stress can activate proinflammatory pathways * antidepressants can decrease inflammatory response * inhibition of inflammatory pathways can improve mood. Exploring these factors and a possible pathway linking inflammation and neurobiologic changes found in depression allows us to look closer at the possible integration of the inflammatory process and depressive symptoms. Illness and depression rates Individuals with inflammatory illnesses--autoimmune diseases, cardiovascular disease, diabetes, and cancer--often struggle with depression. Nearly 1 in 5 persons with cardiovascular disease experiences MDD. (5) A diabetes diagnosis doubles the odds of having depression. (6) Up to 70% of patients with autoimmune diseases, such as rheumatoid arthritis or systemic lupus erythematosus, experience depression. (7), (8) In a large-scale longitudinal study, having a prior autoimmune disease increased the risk of depression by 45% and history of hospitalization with infection increased a patient's risk by 62%; the risk more than doubled in individuals with both. (9) Several studies show that 15% to 25% of cancer patients experience depression, (10) compared with 9% in the general population. (11) Role of inflammatory markers Table Evidence linking inflammation and depression Study Sample Comments Dowlati A meta-analysis of 24 Depressed patients et al, studies measuring had significantly 2010 (14) cytokine concentrations in higher patients with concentrations of MDD TNF-[alpha] and IL-6 compared with controls Maes 15 controls and 35 Serum IL-6 and IL-1 et al, 1997 inpatients with MDD. receptor antagonist (15) Serum IL-6, IL-6 receptor, were higher in IL-1 receptor individuals with antagonist, Clara cell depression protein 16, and or sCD8 were measured at treatment-resistant baseline and at depression compared 5 weeks after with controls antidepressant treatment Raison 162 patients with Thirty-nine percent et al, 2005 hepatitis C infection of subjects (16) were assessed for experienced depressive symptoms moderate to severe at baseline and after 4, depressive symptoms. …