Neuroimaging in Major Depressive Disorder: An Updated Review

重鬱症的神經造影：最新回顧

李俊德(Chun-Te Lee) ； 謝明鴻(Ming-Hong Hsieh) ； 陳錦宏(Chin-Hung Chen) ； 賴德仁(Te-Jen Lai)

《台灣精神醫學》 23卷1期 (2009/03) Pp. 14-29

https://doi.org/10.29478/TJP.200903.0003

摘要

背景：重鬱症（重度憂鬱症）是一種常見且會導致失能的精神疾病，它是一種複雜的疾病，在病理生理學、診斷及治療上存在顯著的異質性。目前，神經造影對於重鬱症的腦部結構及腦部功能已可提供新的觀點與了解。方法：我們使用電腦醫療目錄(Medline)搜尋，以「重鬱症」合併「神經造影」或「腦造影」為主詞加以搜尋2008年5月15日以前已出版的文獻，再從這些文獻搜尋相關的資訊。結果：在重鬱症的神經造影研究上，最一致的發現為大腦前面區域呈現異常，尤其是在額區、扣帶區及邊緣區，這些區域發現：高訊號白質出現的機率增加、白質的完整性出現缺損、膠質細胞的密度降低、大腦血流降低與葡萄糖代謝降低。所以，從諸多神經造影與其他生物學的發現，足可證實重鬱症是一種大腦疾病。而重鬱症在神經造影的局部異常發現，也可應用於臨床診斷與治療評估。對於老年憂鬱症的神經造影，發現存在較多的皮質下缺血性的所謂血管性憂鬱症。對於重鬱症與雙極性疾患的神經造影比較，兩者所影響的腦部區域及臉部表情的神經傳導過程皆不同。對於藥物治療與認知行為治療的神經造影比較，其治療後的神經造影改變皆不同，兩種治療方式雖然影響到相同的腦部局部位置，但是卻以不同的方式呈現。結論：重鬱症的神經造影發現能夠提供重鬱症在病理生理學、診斷及治療上獲得更完整的了解，俾利於提升重鬱症之照護品質。

關鍵字

重鬱症 ； 憂鬱 ； 神經造影

並列摘要

Background: Major depressive disorder (MDD) is one of the prevalent and disabling psychiatric disorders. MDD is a complex disorder with marked heterogeneity in pathophysiology, diagnosis, and treatment. Currently, neuroimaging has given new insights into the structure and function of the brain in individuals with major depression. Methods: We did a Medline search with key words ”major depressive disorder” combined with ”neuroimaging” or ”brain imaging” up to May 15, 2008. We reviewed all identified published articles. Results: The most consistent findings in the pathophysiology studies of MDD with neuroimaging are abnormalities in the anterior regions of the brain, especially frontal, limbic, and cingulate regions, which presenting with increased rate of white matter hyperintensities, defect of white matter integrity, reduced glial cell density, reductions in cerebral flow or glucose metabolism. Thus, MDD is a brain disorder proved by neuroimaging and other biological findings. Findings of the regional abnormalities by neuroimaging may have clinical utility in both diagnosis and treatment of depression. Neuroimaging in geriatric depression found more subcortical ischemic vascular lesion, which is called vascular depression. It is noteworthy that the involved regions of brain and the neural processing of facial expressions may differ between MDD and bipolar disorder. Interestingly, there are clear regional change pattern differences across unique treatments, including medication and cognitive behavior therapy, affecting similar region but in different ways. Conclusion: We conclude that the findings of neuroimaging in individuals with MDD can help clinicians to get comprehensive understanding of depression in pathophysiology, diagnosis and treatment, and to ensure the quality of care in depression.

並列關鍵字

major depressive disorder ； depression ； neuroimaging

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