Learning from negative feedback in patients with major depressive disorder is attenuated by SSRI antidepressants.
Learning from negative feedback in patients with major depressive disorder is attenuated by SSRI antidepressants.
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DOI：
10.3389/fnint.2013.00067
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发表时间：
2013
影响因子：
3.5
通讯作者：
Gluck MA
中科院分区：
文献类型：
--
作者：
Herzallah MM;Moustafa AA;Natsheh JY;Abdellatif SM;Taha MB;Tayem YI;Sehwail MA;Amleh I;Petrides G;Myers CE;Gluck MA
解释过去认知和重度抑郁症（MDD）研究的一个障碍是，许多研究未能充分分离MDD的影响和选择性5 -羟色胺再摄取抑制剂（SSRIs）使用的潜在认知副作用。为了更好地了解抑郁症状的补救如何影响重度抑郁症患者的认知功能，我们评估了三组受试者：medication-naïve重度抑郁症患者、接受SSRI帕罗西汀治疗的重度抑郁症患者和健康对照（HC）受试者。所有人都接受了一项分类学习任务，该任务允许从积极反馈（奖励）中学习与从消极反馈（惩罚）中学习之间的分离。健康被试学习正反馈显著优于medication-naïve组和服药MDD组，其学习准确性无显著差异。相比之下，服用药物的重度抑郁症患者从负面反馈中学习到的知识明显少于medication-naïve重度抑郁症患者和健康受试者，两者的学习准确性相当。对比研究对象对正反馈和负反馈的相对敏感性表明，服药组和HC组都符合前景理论，即预期损失（负反馈）在心理上略大于收益（正反馈）。然而，服药型重度抑郁症和HC的情况并不相似，这表明服药型重度抑郁症的状态与HC相比并不“正常”，而是在正反馈和负反馈的学习较少的情况下达到平衡。另一方面，medication-naïve重度抑郁症患者违反了前景理论，他们从负面反馈中学习的能力明显被夸大。这表明SSRI抗抑郁药损害了负反馈学习，而对正反馈学习的影响可以忽略不计。总的来说，这些发现阐明了将重度抑郁症的认知后果与SSRI治疗的认知后果分离开来的重要性，以及在服用抗抑郁药之前对medication-naïve状态的重度抑郁症受试者进行认知评估的重要性。未来的研究需要将情绪提升效应与基于奖励和惩罚的学习之间的认知平衡联系起来。
One barrier to interpreting past studies of cognition and major depressive disorder (MDD) has been the failure in many studies to adequately dissociate the effects of MDD from the potential cognitive side effects of selective serotonin reuptake inhibitors (SSRIs) use. To better understand how remediation of depressive symptoms affects cognitive function in MDD, we evaluated three groups of subjects: medication-naïve patients with MDD, medicated patients with MDD receiving the SSRI paroxetine, and healthy control (HC) subjects. All were administered a category-learning task that allows for dissociation between learning from positive feedback (reward) vs. learning from negative feedback (punishment). Healthy subjects learned significantly better from positive feedback than medication-naïve and medicated MDD groups, whose learning accuracy did not differ significantly. In contrast, medicated patients with MDD learned significantly less from negative feedback than medication-naïve patients with MDD and healthy subjects, whose learning accuracy was comparable. A comparison of subject’s relative sensitivity to positive vs. negative feedback showed that both the medicated MDD and HC groups conform to Prospect Theory, which expects losses (negative feedback) to loom psychologically slightly larger than gains (positive feedback). However, medicated MDD and HC profiles are not similar, which indicates that the state of medicated MDD is not “normal” when compared to HC, but rather balanced with less learning from both positive and negative feedback. On the other hand, medication-naïve patients with MDD violate Prospect Theory by having significantly exaggerated learning from negative feedback. This suggests that SSRI antidepressants impair learning from negative feedback, while having negligible effect on learning from positive feedback. Overall, these findings shed light on the importance of dissociating the cognitive consequences of MDD from those of SSRI treatment, and from cognitive evaluation of MDD subjects in a medication-naïve state before the administration of antidepressants. Future research is needed to correlate the mood-elevating effects and the cognitive balance between reward- and punishment-based learning related to SSRIs.