Abstract：
Concurrent anxiety is frequent in major depressive disorder and a shared pathophysiological mechanism between anxiety and other depressive symptoms is plausible. The serotonin 4 receptor (5-HT4R) has been implicated in both depression and anxiety. This is the first study to investigate the association between the cerebral 5-HT4R binding and anxiety in patients with depression before and after antidepressant treatment and the association to treatment response. Ninety-one drug-free patients with depression were positron emission tomography scanned with the 5-HT4R ligand [11C]-SB207145. Depression severity and concurrent anxiety was measured at baseline and throughout 8 weeks of antidepressant treatment. Anxiety measures included four domains: anxiety/somatization factor score; Generalized Anxiety Disorder 10-items (GAD-10) score; anxiety/somatization factor score ≥7 (anxious depression) and syndromal anxious depression. Forty patients were rescanned at week 8. At baseline, we found a negative association between global 5-HT4R binding and both GAD-10 score (p < 0.01) and anxiety/somatization factor score (p = 0.06). Further, remitters had a higher baseline anxiety/somatization factor score compared with non-responders (p = 0.04). At rescan, patients with syndromal anxious depression had a greater change in binding relative to patients with non-syndromal depression (p = 0.04). Concurrent anxiety in patients with depression measured by GAD-10 score and anxiety/somatization factor score is negatively associated with cerebral 5-HT4R binding. A lower binding may represent a subtype with reduced natural resilience against anxiety in a depressed state, and concurrent anxiety may influence the effect on the 5-HT4R from serotonergic antidepressants. The 5-HT4R is a promising neuroreceptor for further understanding the underpinnings of concurrent anxiety in patients with depression.
摘要：
并发焦虑在重度抑郁症中很常见，焦虑和其他抑郁症状之间的共同病理生理机制似乎是合理的。5-羟色胺4受体（5-HT4R）与抑郁和焦虑有关。这是第一项研究抗抑郁药治疗前后抑郁症患者的大脑5-HT4R结合与焦虑之间的关系以及与治疗反应的关系。用5-HT4R配体[11C]-SB207145扫描了91名无药抑郁症患者的正电子发射断层扫描。在基线和整个8周的抗抑郁治疗中测量抑郁严重程度和并发焦虑。焦虑测量包括四个领域：焦虑/躯体化因子得分；广泛性焦虑症10项（GAD-10）得分；焦虑/躯体化因子得分≥7（焦虑抑郁）和综合征性焦虑抑郁。在第8周重新扫描了40名患者。在基线,我们发现总体5-HT4R结合与GAD-10评分(p<0.01)和焦虑/躯体化因子评分(p=0.06)呈负相关.Further,与无反应者相比,缓解者的基线焦虑/躯体化因子得分较高(p=0.04).在重新扫描时，与非综合征性抑郁患者相比,综合征性焦虑抑郁患者的结合力变化更大(p=0.04).通过GAD-10评分和焦虑/躯体化因子评分测量的抑郁症患者并发焦虑与大脑5-HT4R结合呈负相关。较低的结合可能代表在抑郁状态下对焦虑的自然复原力降低的亚型。同时焦虑可能会影响5-羟色胺能抗抑郁药对5-HT4R的作用。5-HT4R是一种有前途的神经受体，可进一步了解抑郁症患者并发焦虑的基础。
