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Abstract：
Patients with major depressive disorder (MDD) exhibit an abnormal physiological arousal pattern known as hyperarousal, which may contribute to their depressive symptoms. However, the neurobiological mechanisms linking this abnormal arousal to depressive symptoms are not yet fully understood. In this review, we summarize the physiological and neural features of arousal, and review the literature indicating abnormal arousal in depressed patients. Evidence suggests that a hyperarousal state in depression is characterized by abnormalities in sleep behavior, physiological (e.g., heart rate, skin conductance, pupil diameter) and electroencephalography (EEG) features, and altered activity in subcortical (e.g., hypothalamus and locus coeruleus) and cortical regions. While recent studies highlight the importance of subcortical-cortical interactions in arousal, few have explored the relationship between subcortical-cortical interactions and hyperarousal in depressed patients. This gap limits our understanding of the neural mechanism through which hyperarousal affects depressive symptoms, which involves various cognitive processes and the cerebral cortex. Based on the current literature, we propose that the hyperconnectivity in the thalamocortical circuit may contribute to both the hyperarousal pattern and depressive symptoms. Future research should investigate the relationship between thalamocortical connections and abnormal arousal in depression, and explore its implications for non-invasive treatments for depression.
摘要：
患有重度抑郁症（MDD）的患者表现出一种异常的生理唤醒模式，称为过度唤醒，这可能会导致他们的抑郁症状。然而,这种异常唤醒与抑郁症状的神经生物学机制尚未完全了解。在这次审查中,我们总结了唤醒的生理和神经特征，并回顾了抑郁症患者异常唤醒的文献。证据表明，抑郁症的过度觉醒状态以睡眠行为异常为特征，生理(例如，心率,皮肤电导,瞳孔直径）和脑电图（EEG）特征，和皮质下的活动改变(例如，下丘脑和蓝斑）和皮质区域。虽然最近的研究强调了皮层下-皮层相互作用在唤醒中的重要性，很少有人探讨抑郁症患者皮质下-皮质相互作用与过度觉醒之间的关系。这种差距限制了我们对过度觉醒影响抑郁症状的神经机制的理解，涉及各种认知过程和大脑皮层。根据目前的文献，我们认为，丘脑皮质回路的超连通性可能导致过度觉醒和抑郁症状。未来的研究应该调查丘脑皮质连接与抑郁症异常唤醒之间的关系，并探讨其对抑郁症非侵入性治疗的意义。
