杏仁核反应性、抗抑郁药停药和复发

IF 22.5 1区 医学 Q1 PSYCHIATRY JAMA Psychiatry Pub Date : 2024-09-11 DOI:10.1001/jamapsychiatry.2024.2136
Tore Erdmann, Isabel M. Berwian, Klaas Enno Stephan, Erich Seifritz, Henrik Walter, Quentin J. M. Huys
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Amygdala reactivity to negative information is a marker of negative affective processes in depression that is reduced by antidepressant medication, but it is unknown whether amygdala reactivity is sensitive to antidepressant discontinuation or whether any change is related to the risk of relapse after antidepressant discontinuation.ObjectiveTo investigate whether amygdala reactivity to negative facial emotions changes with antidepressant discontinuation and is associated with subsequent relapse.Design, Setting, and ParticipantsThe Antidepressiva Absetzstudie (AIDA) study was a longitudinal, observational study in which adult patients with remitted major depressive disorder (MDD) and currently taking antidepressants underwent 2 task-based functional magnetic resonance imaging (fMRI) measurements of amygdala reactivity. Patients were randomized to discontinuing antidepressants either before or after the second fMRI measurement. Relapse was monitored over a 6-month follow-up period. Study recruitment took place from June 2015 to January 2018. Data were collected between July 1, 2015, and January 31, 2019, and statistical analyses were conducted between June 2021 and December 2023. The study took place in a university setting in Zurich, Switzerland, and Berlin, Germany. Of 123 recruited patients, 83 were included in analyses. Of 66 recruited healthy control individuals matched for age, sex, and education, 53 were included in analyses.ExposureDiscontinuation of antidepressant medication.OutcomesTask-based fMRI measurement of amygdala reactivity and MDD relapse within 6 months after discontinuation.ResultsAmong patients with MDD, the mean (SD) age was 35.42 (11.41) years, and 62 (75%) were women. Among control individuals, the mean (SD) age was 33.57 (10.70) years, and 37 (70%) were women. Amygdala reactivity of patients with remitted MDD and taking medication did not initially differ from that of control individuals (<jats:italic>t</jats:italic><jats:sub>125.136</jats:sub> = 0.33; <jats:italic>P</jats:italic> <jats:italic>=</jats:italic> .74). An increase in amygdala reactivity after antidepressant discontinuation was associated with depression relapse (3-way interaction between group [12W (waited) vs 1W2 (discontinued)], time point [MA1 (first scan) vs MA2 (second scan)], and relapse: β, 18.9; 95% CI, 0.8-37.1; <jats:italic>P</jats:italic> <jats:italic>=</jats:italic> .04). 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引用次数: 0

摘要

重要性停用抗抑郁药会大大增加抑郁症复发的风险,但造成这种情况的神经生物学机制尚不清楚。杏仁核对负面信息的反应性是抑郁症患者负面情绪过程的一个标记,抗抑郁药物会降低杏仁核的反应性,但杏仁核反应性是否对停用抗抑郁药物敏感,或者任何变化是否与停用抗抑郁药物后的复发风险有关,目前尚不清楚。设计、环境和参与者抗抑郁药物研究(AIDA)是一项纵向观察性研究,研究对象是目前正在服用抗抑郁药物的重度抑郁症(MDD)缓解期成年患者,他们接受了两次基于任务的杏仁核反应性功能磁共振成像(fMRI)测量。患者被随机分配在第二次fMRI测量之前或之后停用抗抑郁药。在为期6个月的随访期间对复发情况进行监测。研究招募时间为2015年6月至2018年1月。数据收集时间为 2015 年 7 月 1 日至 2019 年 1 月 31 日,统计分析时间为 2021 年 6 月至 2023 年 12 月。研究在瑞士苏黎世和德国柏林的一所大学进行。在招募的 123 名患者中,有 83 人被纳入分析。结果基于任务的杏仁核反应性 fMRI 测量和 MDD 在停药后 6 个月内的复发结果在 MDD 患者中,平均(标清)年龄为 35.42(11.41)岁,女性 62 人(75%)。对照组患者的平均年龄(标准差)为 33.57(10.70)岁,37(70%)人为女性。缓解型 MDD 患者的杏仁核反应性最初与服用药物的对照组患者没有差异(t125.136 = 0.33;P = .74)。停用抗抑郁药后杏仁核反应性的增加与抑郁症复发有关(组别[12W(等待) vs 1W2(停药)]、时间点[MA1(第一次扫描) vs MA2(第二次扫描)]和复发之间的三方交互作用:β,18.9;95% CI,0.8-37.1;P = .04)。杏仁核反应性变化与更短的复发时间相关(危险比,1.05;95% CI,1.01-1.09;P = .01),并可预测复发(留空交叉验证平衡准确率,67%;95% 后预测区间,53-80;P = .02)。结论和相关性杏仁核反应性的增加与停用抗抑郁药后的复发风险有关,它可能是一种功能性神经影像标记,可为停用抗抑郁药的临床决策提供依据。
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Amygdala Reactivity, Antidepressant Discontinuation, and Relapse
ImportanceAntidepressant discontinuation substantially increases the risk of a depression relapse, but the neurobiological mechanisms through which this happens are not known. Amygdala reactivity to negative information is a marker of negative affective processes in depression that is reduced by antidepressant medication, but it is unknown whether amygdala reactivity is sensitive to antidepressant discontinuation or whether any change is related to the risk of relapse after antidepressant discontinuation.ObjectiveTo investigate whether amygdala reactivity to negative facial emotions changes with antidepressant discontinuation and is associated with subsequent relapse.Design, Setting, and ParticipantsThe Antidepressiva Absetzstudie (AIDA) study was a longitudinal, observational study in which adult patients with remitted major depressive disorder (MDD) and currently taking antidepressants underwent 2 task-based functional magnetic resonance imaging (fMRI) measurements of amygdala reactivity. Patients were randomized to discontinuing antidepressants either before or after the second fMRI measurement. Relapse was monitored over a 6-month follow-up period. Study recruitment took place from June 2015 to January 2018. Data were collected between July 1, 2015, and January 31, 2019, and statistical analyses were conducted between June 2021 and December 2023. The study took place in a university setting in Zurich, Switzerland, and Berlin, Germany. Of 123 recruited patients, 83 were included in analyses. Of 66 recruited healthy control individuals matched for age, sex, and education, 53 were included in analyses.ExposureDiscontinuation of antidepressant medication.OutcomesTask-based fMRI measurement of amygdala reactivity and MDD relapse within 6 months after discontinuation.ResultsAmong patients with MDD, the mean (SD) age was 35.42 (11.41) years, and 62 (75%) were women. Among control individuals, the mean (SD) age was 33.57 (10.70) years, and 37 (70%) were women. Amygdala reactivity of patients with remitted MDD and taking medication did not initially differ from that of control individuals (t125.136 = 0.33; P = .74). An increase in amygdala reactivity after antidepressant discontinuation was associated with depression relapse (3-way interaction between group [12W (waited) vs 1W2 (discontinued)], time point [MA1 (first scan) vs MA2 (second scan)], and relapse: β, 18.9; 95% CI, 0.8-37.1; P = .04). Amygdala reactivity change was associated with shorter times to relapse (hazard ratio, 1.05; 95% CI, 1.01-1.09; P = .01) and predictive of relapse (leave-one-out cross-validation balanced accuracy, 67%; 95% posterior predictive interval, 53-80; P = .02).Conclusions and RelevanceAn increase in amygdala reactivity was associated with risk of relapse after antidepressant discontinuation and may represent a functional neuroimaging marker that could inform clinical decisions around antidepressant discontinuation.
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来源期刊
JAMA Psychiatry
JAMA Psychiatry PSYCHIATRY-
CiteScore
30.60
自引率
1.90%
发文量
233
期刊介绍: JAMA Psychiatry is a global, peer-reviewed journal catering to clinicians, scholars, and research scientists in psychiatry, mental health, behavioral science, and related fields. The Archives of Neurology & Psychiatry originated in 1919, splitting into two journals in 1959: Archives of Neurology and Archives of General Psychiatry. In 2013, these evolved into JAMA Neurology and JAMA Psychiatry, respectively. JAMA Psychiatry is affiliated with the JAMA Network, a group of peer-reviewed medical and specialty publications.
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