抑郁障碍和焦虑障碍治疗的神经心理机制——脑成像研究的ALE元分析

抑郁障碍和焦虑障碍是两种最常见的精神障碍。使用激活似然估计(activation likelihood estimation,ALE)元分析对抑郁和焦虑障碍患者治疗后出现的一致脑区激活改变进行评估,并考察不同条件下这一改变的差异。研究共纳入25篇文献,结果发现:(1)抑郁和焦虑障碍接受治疗后,枕下回(inferior occipital gyrus,IOG)等脑区激活增加;豆状核(lentiform nucleus)等激活减少。(2)a.心理治疗产生的脑激活改变为豆状核活动的减少;药物治疗则在于扣带回(cingulate gyrus)等活动增加,而楔前叶(precuneus)等活动减少。b.任务下成像治疗后激活增加的脑区为扣带回等,减少的脑区为楔前叶等;静息下成像,治疗后枕下回等激活增加,额内侧回(medial frontal gyrus,MFG)等激活减少。c.抑郁障碍治疗后的脑激活变化为扣带回等活动增加,楔前叶等活动减少;焦虑障碍在于前扣带回/额内侧回(anterior cingulate/MFG)活动减少。研究表明治疗会给抑郁和焦虑障碍带来一致的脑区激活改变;治疗方法、成像状态和障碍类型不同,治疗后脑区激活改变也存在差异。

The neuropsychological mechanism of therapy in depression and anxiety disorder: A meta-analysis of functional neuroimaging studies

Some commonality is assumed between depression and anxiety disorder in terms of brain regions that are responsible for the disorder and treatment effect. However empirical evidence is lacking due to the fact that most studies investigating treatment effect on activating change in abnormal brain regions only focused on one of the two disorders. The current study, using meta-analysis, explored the types of neuropsychological commonality between depression and anxiety disorder. Additionally, discrepancies in brain activity change between depression and anxiety disorder due to treatment methods (psychotherapy or pharmacological treatment) and task states (resting state or task state) when brain activity is recorded were also investigated. The activation likelihood estimation (ALE) was used to conduct the meta-analysis of studies with neuroimaging data. There were twenty-five studies met the inclusion criteria, containing 15 depression and 10 anxiety studies, of which among them 10 experiments used psychotherapy and 16 pharmacological therapy. In terms of task state, 12 experiments recorded the brain activity in a resting state and 13 in a task state. The meta-analysis was conducted under standard Talairach space, and we translated those reported results using Montreal Neurological Institute (MNI) coordinated into Talairach coordinate. The probability maps usedp < 0.001 as threshold and corrected it using Uncorrected P. The minimum cluster size was set at 250 mm3. In order to provide a visual view of activation distributions, we used the Mango software to project the activation coordinates onto a brain template. Results showed that there were similar changes in some brain regions between depression and anxiety disorder after treatment, namely the activation of inferior occipital gyrus, cingulate gyrus, superior parietal lobule and lentiform nucleus increased, and that of lentiform nucleus, inferior frontal gyrus, medial frontal gyrus, precuneus, anterior cingulate and middle frontal gyrus decreased. When using disorder type as classification, the analysis showed that both types of treatment of depression led to increased activity in cingulate gyrus, inferior occipital gyrus, superior parietal lobule and precuneus, and decreased activity in precuneus, inferior frontal gyrus, lentiform nucleus, superior temporal gyrus, middle temporal gyrus, parahippocampal gyrus, middle frontal gyrus, thalamus and postcentral gyrus, while both treatments of anxiety resulted in decreased activity in anterior cingulate/medial frontal gyrus. When using therapeutic method as classification, psychotherapy led to deactivation of lentiform nucleus, while pharmacological therapy gave rise to activation in cingulate gyrus, superior parietal lobule and precuneus and deactivation in precuneus, culmen, lentiform nucleus, supramarginal gyrus, superior temporal gyrus, middle temporal gyrus, parahippocampal gyrus, inferior frontal gyrus, insula, superior parietal lobule and anterior cingulate gyrus. Finally, when using task state as classification, the analysis showed that after either type of treatment, the activity of inferior occipital gyrus and fusiform gyrus increased and that of medial frontal gyrus, inferior frontal gyrus, middle frontal gyrus, thalamus and insula activation decreased in the resting state; while the brain activity in the task state was increased in cingulate gyrus, lentiform nucleus, superior parietal lobule and precuneus, and decreased in precuneus, lentiform nucleus, supramarginal gyrus and many other areas. In sum, the current meta-analysis suggested that both psychotherapy and pharmacological treatments led to some similar changes of brain activity among patients with depression or anxiety disorder. Further, disorder type, therapeutic method, and task state played a role in the difference of brain activation after either type of treatment. The current study provided neuropathological support for using either psychotherapy and pharmacological treatment to treat depression and anxiety disorder.