理解抑郁症和焦虑症的生物应激系统失调的综合方法

背景

情感障碍涉及主要生物应激系统（下丘脑-垂体-肾上腺（HPA）轴，免疫系统，自主神经系统（ANS））的调节异常。很少在不同的压力系统中同时检查这种失调。

方法

在荷兰抑郁症和焦虑症研究（n = 2789）中，我们调查了当前或缓解的抑郁症和/或焦虑症（基于CIDI半结构化访谈），包括特定的症状特征，是否与单独的标志物和累积指标相关联HPA轴（皮质醇唤醒反应，夜间皮质醇，地塞米松抑制试验皮质醇），免疫系统（C反应蛋白，白介素-6，肿瘤坏死因子-α）和ANS（心率，呼吸道窦性心律不齐，弹射期）。

结果

抑郁和焦虑症与三种生物应激系统的变化显着相关，包括HPA轴亢进，炎症活动增加和ANS音调升高，尤其是与对照组相比，这些应激系统的综合指数和累积指数（pFDR <.05）。与当前的HPA轴疾病和累积指数（β= .124，pFDR = .001），免疫系统（β= .057，pFDR = .032）以及整个应激系统的总累积指数之间存在最强的关联（ β= .102，pFDR = .004）。与能量相关的非典型抑郁症严重程度与免疫系统标志物（pFDR <0.001），忧郁抑郁症严重程度与HPA轴标志物（pFDR = .032）相关，而与焦虑相关的严重程度与HPA轴心和免疫系统标志物相关（pFDR < 0.05）。较差的生活方式，更多的慢性疾病，

局限性

横断面分析限制了时间关联的检查。

结论

抑郁症和焦虑症患者在整个生物应激系统中表现出持续的失调，尤其是对于当前的发作。要了解情感性疾病中的应激系统功能，一种综合的方法应能够捕获生物应激系统内部和整个生物应激系统的累积压力指标。

Background

Affective disorders involve dysregulation of major biological stress systems (hypothalamic-pituitary-adrenal (HPA)-axis, immune system, autonomic nervous system (ANS)). Suchdysregulationshave rarely beensimultaneously examined across different stress systems.

Methods

In the Netherlands Study of Depression and Anxiety (n=2789), we investigated whether current or remitted depressive and/or anxiety disorders (based on the CIDI semi-structured interview), including specific symptom profiles, were associated with separate markers and cumulative indexes of the HPA-axis (cortisol awakening response, evening cortisol, dexamethasone suppression test cortisol), immune system (C-reactive protein, interleukin-6, tumor necrosis factor-α), and ANS (heart rate, respiratory sinus arrhythmia, pre-ejection period).

Results

Depressive andanxiety disorderswere significantlyassociated with changes in three biological stress systemsincluding HPA-axis hyperactivity, increased inflammatory activity, and a higher ANS tone, particularly for integrative and cumulative indexes of these stress systems (pFDR <.05) vs. controls. The strongest associations were seen with current disorders andcumulative indexes of the HPA-axis (β=.124, pFDR=.001), the immune system (β =.057, pFDR=.032), and total cumulative index across stress systems (β=.102, pFDR=.004). Atypical, energy-related depression severity was linked to immune system markers (pFDR<0.001), melancholic depression severity to HPA-axis markers (pFDR=.032), and anxiety arousal severity to both HPA-axis and immune system markers (pFDR<0.05). Findings were partially explained by poorer lifestyle, more chronic diseases,or (especially for ANS-function) antidepressant use.

Limitations

Cross-sectional analyses limit examination of temporal associations.

Conclusion

Patients withdepressive and anxiety disorders showed consistent dysregulation across biological stress systems, particularly for current episodes.To understand stress system functionality in affective disorders, an integrated approach capturing cumulative stress indices within and across biological stress systems is important.