睡眠、失眠和抑郁。,Neuropsychopharmacology

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睡眠、失眠和抑郁。
Neuropsychopharmacology ( IF 6.6 ) Pub Date : 2019-05-09 , DOI: 10.1038/s41386-019-0411-y
Dieter Riemann ₁ , Lukas B Krone _{2,

3} , Katharina Wulff _{4,

5} , Christoph Nissen ₆

Affiliation

自古以来，人们就知道忧郁症和睡眠障碍会同时发生。将多导睡眠图引入精神病学研究证实了抑郁症患者的睡眠连续性受到干扰，不仅显示慢波睡眠减少，而且显示 REM（快速眼动）睡眠的去抑制，表现为 REM 潜伏期的缩短， REM 密度以及总 REM 睡眠时间增加。最初希望这些 REM 睡眠异常可能作为抑郁症亚型的鉴别诊断标志物并没有实现。几乎所有的抗抑郁药都会抑制 REM 睡眠，并且总 REM 睡眠抑制与治疗反应之间的时间和剂量反应关系似乎很明显。所谓的胆碱能 REM 诱导测试表明，REM 睡眠异常可以通过使用拟胆碱药来模拟。另一个重要的研究途径是研究睡眠剥夺和光照的时间医学时间对抑郁症情绪的积极影响。目前的研究认为失眠，即睡眠潜伏期延长、睡眠维持问题和清晨醒来，作为许多精神障碍的跨诊断症状，与抑郁症的关系最密切。从不同角度研究失眠作为一种跨诊断表型，为研究机制和临床实践开辟了许多新的视角。因此，问题是：失眠的早期充分治疗能预防抑郁症吗？本文将当前对睡眠调节机制的理解与有关抑郁症引起的生理变化的知识联系起来。该综述旨在引起人们对睡眠和抑郁疗法益处的研究和临床实践中当前和未来策略的关注。

"点击查看英文标题和摘要"

Sleep, insomnia, and depression.

Since ancient times it is known that melancholia and sleep disturbances co-occur. The introduction of polysomnography into psychiatric research confirmed a disturbance of sleep continuity in patients with depression, revealing not only a decrease in Slow Wave Sleep, but also a disinhibition of REM (rapid eye movement) sleep, demonstrated as a shortening of REM latency, an increase of REM density, as well as total REM sleep time. Initial hopes that these abnormalities of REM sleep may serve as differential-diagnostic markers for subtypes of depression were not fulfilled. Almost all antidepressant agents suppress REM sleep and a time-and-dose-response relationship between total REM sleep suppression and therapeutic response to treatment seemed apparent. The so-called Cholinergic REM Induction Test revealed that REM sleep abnormalities can be mimicked by administration of cholinomimetic agents. Another important research avenue is the study of chrono-medical timing of sleep deprivation and light exposure for their positive effects on mood in depression. Present day research takes the view on insomnia, i.e., prolonged sleep latency, problems to maintain sleep, and early morning awakening, as a transdiagnostic symptom for many mental disorders, being most closely related to depression. Studying insomnia from different angles as a transdiagnostic phenotype has opened many new perspectives for research into mechanisms but also for clinical practice. Thus, the question is: can the early and adequate treatment of insomnia prevent depression? This article will link current understanding about sleep regulatory mechanisms with knowledge about changes in physiology due to depression. The review aims to draw the attention to current and future strategies in research and clinical practice to the benefits of sleep and depression therapeutics.

更新日期：2019-05-16

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