Adolescent depression: stress and reward dysfunction.
Adolescent depression: stress and reward dysfunction.
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DOI：
10.1097/hrp.0000000000000034
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发表时间：
2014-05
影响因子：
3.8
通讯作者：
Pizzagalli DA
中科院分区：
文献类型：
--
作者：
Auerbach RP;Admon R;Pizzagalli DA
青春期是抑郁症发作的高峰期，也是一个充满压力和大脑奖励回路神经发育的时期。在目前的审查中，我们提供了一个选择性的概述，目前动物和人类的研究调查奖励过程，压力和抑郁症之间的关系。三个独立的，但相关的，病因学模型研究不同的角色，压力可能发挥奖励功能障碍和青少年抑郁症。首先，奖励中介模型表明，急性和慢性压力有助于奖励赤字，这反过来又会增强抑郁症状和/或增加抑郁症的风险。第二，根据压力产生的观点，病前奖励相关功能障碍产生压力，特别是人际压力，然后导致抑郁症状的表现是合理的。最后，与素质压力模型一致，压力和病前奖励功能障碍之间的相互作用可能有助于抑郁症的发病。考虑到抑郁症的等同性，这些模型可以揭示青春期不同的病因学途径，特别是因为它们可能与理解抑郁症的异质性有关。为了突出这些见解的翻译潜力，提供了一个假设的案例研究作为手段，证明了在评估和治疗青少年抑郁症的目标奖励功能障碍的重要性。
Adolescence is a peak period for the onset of depression, and it is also a time marked by substantial stress as well as neural development within the brain reward circuitry. In the current review, we provide a selective overview of current animal and human research investigating the relationship among reward processes, stress, and depression. Three separate, but related, etiological models examine the differential roles that stress may play with regard to reward dysfunction and adolescent depression. First, the reward mediation model suggests that acute and chronic stress contribute to reward deficits, which in turn, potentiate depressive symptoms and/or increase the risk for depression. Second, in line with the stress generation perspective, it is plausible that premorbid reward-related dysfunction generates stress, in particular interpersonal stress, which then leads to the manifestation of depressive symptoms. Last, consistent with a diathesis-stress model, the interaction between stress and premorbid reward dysfunction may contribute to the onset of depression. Given the equifinal nature of depression, these models could shed important light on different etiological pathways during adolescence, particularly as they may relate to understanding the heterogeneity of depression. To highlight the translational potential of these insights, a hypothetical case study is provided as means of demonstrating the importance of targeting reward dysfunction in both assessment and treatment of adolescent depression.