抑郁症临床亚型相关研究综述
A Review of Related Research on Clinical Subtypes of Depression
摘要: 抑郁症是一种高度异质性疾病,具有高发病率和高复发率等特点。抑郁症患者的症状特征、临床轨迹和治疗结果因人而异,表明存在不同的临床亚型。近年来,越来越多的研究尝试通过识别临床亚型,以提高抑郁症的诊断同质性并推动精准治疗的发展。文章总结了常用的抑郁症临床分型的方案,探讨分型面临的挑战和未来的方向。在今后的研究中,通过设计标准化的研究方案、比较不同亚型之间潜在的生物标志物的差异,将有助于更好地理解潜在的疾病机制、预测预后以及制定个体化精准治疗策略。未来应在大样本、多模态的研究框架下,结合遗传学、神经影像与机器学习方法,建立精准的抑郁症亚型划分体系。
Abstract: Depression is a highly heterogeneous disorder characterized by high prevalence and recurrence rates. The symptom profiles, clinical trajectories, and treatment outcomes of patients with depression vary substantially among individuals, suggesting the existence of distinct clinical subtypes. In recent years, increasing efforts have been made to identify these subtypes to enhance diagnostic homogeneity and advance precision treatment. This paper summarizes the commonly used clinical classification schemes for depression, discusses the challenges faced in subtype identification, and outlines potential future directions. In future research, the design of standardized study protocols and the comparison of potential biological markers across subtypes will facilitate a better understanding of underlying disease mechanisms, improve prognostic prediction, and guide the development of individualized and precise therapeutic strategies. Future studies should adopt large-sample, multimodal research frameworks integrating genetics, neuroimaging, and machine learning approaches to establish a biologically informed and precise classification system for depressive disorders.
文章引用:余青. 抑郁症临床亚型相关研究综述[J]. 社会科学前沿, 2026, 15(1): 108-115. https://doi.org/10.12677/ass.2026.151014

参考文献

[1] Leone, M., Kuja-Halkola, R., Leval, A., D’Onofrio, B.M., Larsson, H., Lichtenstein, P., et al. (2021) Association of Youth Depression with Subsequent Somatic Diseases and Premature Death. JAMA Psychiatry, 78, 302-310. [Google Scholar] [CrossRef] [PubMed]
[2] World Health Organization (2008) The Global Burden of Disease. WHO.
https://iris.who.int/bitstream/handle/10665/254610/W?sequence=1
[3] Hasler, G. (2010) Pathophysiology of Depression: Do We Have Any Solid Evidence of Interest to Clinicians? World Psychiatry, 9, 155-161. [Google Scholar] [CrossRef] [PubMed]
[4] Krishnan, V. and Nestler, E.J. (2008) The Molecular Neurobiology of Depression. Nature, 455, 894-902. [Google Scholar] [CrossRef] [PubMed]
[5] Milaneschi, Y., Lamers, F., Peyrot, W.J., Abdellaoui, A., Willemsen, G., Hottenga, J., et al. (2015) Polygenic Dissection of Major Depression Clinical Heterogeneity. Molecular Psychiatry, 21, 516-522. [Google Scholar] [CrossRef] [PubMed]
[6] Ozomaro, U., Wahlestedt, C. and Nemeroff, C.B. (2013) Personalized Medicine in Psychiatry: Problems and Promises. BMC Medicine, 11, Article No. 132. [Google Scholar] [CrossRef] [PubMed]
[7] Simon, G.E. and Perlis, R.H. (2010) Personalized Medicine for Depression: Can We Match Patients with Treatments? American Journal of Psychiatry, 167, 1445-1455. [Google Scholar] [CrossRef] [PubMed]
[8] American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association.
[9] Drysdale, A.T., Grosenick, L., Downar, J., Dunlop, K., Mansouri, F., Meng, Y., et al. (2016) Resting-State Connectivity Biomarkers Define Neurophysiological Subtypes of Depression. Nature Medicine, 23, 28-38. [Google Scholar] [CrossRef] [PubMed]
[10] Wang, Y., Tang, S., Zhang, L., Bu, X., Lu, L., Li, H., et al. (2021) Data-Driven Clustering Differentiates Subtypes of Major Depressive Disorder with Distinct Brain Connectivity and Symptom Features. The British Journal of Psychiatry, 219, 606-613. [Google Scholar] [CrossRef] [PubMed]
[11] Harald, B. and Gordon, P. (2012) Meta-Review of Depressive Subtyping Models. Journal of Affective Disorders, 139, 126-140. [Google Scholar] [CrossRef] [PubMed]
[12] Lichtenberg, P. and Belmaker, R.H. (2010) Subtyping Major Depressive Disorder. Psychotherapy and Psychosomatics, 79, 131-135. [Google Scholar] [CrossRef] [PubMed]
[13] Parker, G., Fink, M., Shorter, E., Taylor, M.A., Akiskal, H., Berrios, G., et al. (2010) Issues for DSM-5: Whither Melancholia? The Case for Its Classification as a Distinct Mood Disorder. American Journal of Psychiatry, 167, 745-747. [Google Scholar] [CrossRef] [PubMed]
[14] Bracht, T., Horn, H., Strik, W., Federspiel, A., Schnell, S., Höfle, O., et al. (2014) White Matter Microstructure Alterations of the Medial Forebrain Bundle in Melancholic Depression. Journal of Affective Disorders, 155, 186-193. [Google Scholar] [CrossRef] [PubMed]
[15] Denier, N., Walther, S., Schneider, C., Federspiel, A., Wiest, R. and Bracht, T. (2020) Reduced Tract Length of the Medial Forebrain Bundle and the Anterior Thalamic Radiation in Bipolar Disorder with Melancholic Depression. Journal of Affective Disorders, 274, 8-14. [Google Scholar] [CrossRef] [PubMed]
[16] Pizzagalli, D.A., Oakes, T.R., Fox, A.S., Chung, M.K., Larson, C.L., Abercrombie, H.C., et al. (2003) Functional but Not Structural Subgenual Prefrontal Cortex Abnormalities in Melancholia. Molecular Psychiatry, 9, 393-405. [Google Scholar] [CrossRef
[17] van Diermen, L., Vanmarcke, S., Walther, S., Moens, H., Veltman, E., Fransen, E., et al. (2019) Can Psychomotor Disturbance Predict ECT Outcome in Depression? Journal of Psychiatric Research, 117, 122-128. [Google Scholar] [CrossRef] [PubMed]
[18] Dubovsky, S.L., Ghosh, B.M., Serotte, J.C. and Cranwell, V. (2020) Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment. Psychotherapy and Psychosomatics, 90, 160-177. [Google Scholar] [CrossRef] [PubMed]
[19] Roat, D.B. (2009) Clinical Manual for Diagnosis and Treatment of Psychotic Depression. Psychiatric Services, 60, 1144-1145. [Google Scholar] [CrossRef
[20] Juruena, M.F. and Cleare, A.J. (2007) Overlap between Atypical Depression, Seasonal Affective Disorder and Chronic Fatigue Syndrome. Brazilian Journal of Psychiatry, 29, s19-s26. [Google Scholar] [CrossRef] [PubMed]
[21] Lin, C., Wang, F., Lin, S., Chen, C. and Huang, C. (2014) A Comparison of Inpatients with Anxious Depression to Those with Nonanxious Depression. Psychiatry Research, 220, 855-860. [Google Scholar] [CrossRef] [PubMed]
[22] Fava, M., Alpert, J.E., Carmin, C.N., Wisniewski, S.R., Trivedi, M.H., Biggs, M.M., et al. (2004) Clinical Correlates and Symptom Patterns of Anxious Depression among Patients with Major Depressive Disorder in STAR*D. Psychological Medicine, 34, 1299-1308. [Google Scholar] [CrossRef] [PubMed]
[23] Fava, M., Rush, A.J., Alpert, J.E., Carmin, C.N., Balasubramani, G., Wisniewski, S.R., et al. (2006) What Clinical and Symptom Features and Comorbid Disorders Characterize Outpatients with Anxious Major Depressive Disorder: A Replication and Extension. The Canadian Journal of Psychiatry, 51, 823-835. [Google Scholar] [CrossRef] [PubMed]
[24] Joffe, R.T., Bagby, R.M. and Levitt, A. (1993) Anxious and Nonanxious Depression. The American Journal of Psychiatry, 150, 1257-1258.
[25] Wiethoff, K., Bauer, M., Baghai, T.C., Möller, H., Fisher, R., Hollinde, D., et al. (2010) Prevalence and Treatment Outcome in Anxious versus Nonanxious Depression. The Journal of Clinical Psychiatry, 71, 1047-1054. [Google Scholar] [CrossRef] [PubMed]
[26] Rush, A.J. (2007) The Varied Clinical Presentations of Major Depressive Disorder. The Journal of Clinical Psychiatry, 68, 4-10.
[27] Panza, F., Frisardi, V., Capurso, C., D’Introno, A., Colacicco, A.M., Imbimbo, B.P., et al. (2010) Late-Life Depression, Mild Cognitive Impairment, and Dementia: Possible Continuum? The American Journal of Geriatric Psychiatry, 18, 98-116. [Google Scholar] [CrossRef] [PubMed]
[28] Korten, N.C.M., Comijs, H.C., Lamers, F. and Penninx, B.W.J.H. (2012) Early and Late Onset Depression in Young and Middle Aged Adults: Differential Symptomatology, Characteristics and Risk Factors? Journal of Affective Disorders, 138, 259-267. [Google Scholar] [CrossRef] [PubMed]
[29] Howland, R.H. (2009) An Overview of Seasonal Affective Disorder and Its Treatment Options. The Physician and Sportsmedicine, 37, 104-115. [Google Scholar] [CrossRef] [PubMed]
[30] Rosenthal, N.E. (1984) Seasonal Affective Disorder: A Description of the Syndrome and Preliminary Findings with Light Therapy. Archives of General Psychiatry, 41, 72-80. [Google Scholar] [CrossRef] [PubMed]
[31] Magnusson, A. (2000) An Overview of Epidemiological Studies on Seasonal Affective Disorder. Acta Psychiatrica Scandinavica, 101, 176-184. [Google Scholar] [CrossRef] [PubMed]
[32] Nguyen, T., Harder, A., Xiong, Y., Kowalec, K., Hägg, S., Cai, N., et al. (2022) Genetic Heterogeneity and Subtypes of Major Depression. Molecular Psychiatry, 27, 1667-1675. [Google Scholar] [CrossRef] [PubMed]
[33] Price, R.B., Gates, K., Kraynak, T.E., Thase, M.E. and Siegle, G.J. (2017) Data-Driven Subgroups in Depression Derived from Directed Functional Connectivity Paths at Rest. Neuropsychopharmacology, 42, 2623-2632. [Google Scholar] [CrossRef] [PubMed]
[34] Ballard, E.D., Yarrington, J.S., Farmer, C.A., Richards, E., Machado-Vieira, R., Kadriu, B., et al. (2018) Characterizing the Course of Suicidal Ideation Response to Ketamine. Journal of Affective Disorders, 241, 86-93. [Google Scholar] [CrossRef] [PubMed]
[35] Maglanoc, L.A., Landrø, N.I., Jonassen, R., Kaufmann, T., Córdova-Palomera, A., Hilland, E., et al. (2019) Data-Driven Clustering Reveals a Link between Symptoms and Functional Brain Connectivity in Depression. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 4, 16-26. [Google Scholar] [CrossRef] [PubMed]
[36] Tokuda, T., Yoshimoto, J., Shimizu, Y., Okada, G., Takamura, M., Okamoto, Y., et al. (2018) Identification of Depression Subtypes and Relevant Brain Regions Using a Data-Driven Approach. Scientific Reports, 8, Article 1. [Google Scholar] [CrossRef] [PubMed]
[37] Sun, X., Sun, J., Lu, X., Dong, Q., Zhang, L., Wang, W., et al. (2023) Mapping Neurophysiological Subtypes of Major Depressive Disorder Using Normative Models of the Functional Connectome. Biological Psychiatry, 94, 936-947. [Google Scholar] [CrossRef] [PubMed]
[38] Chen, D., Wang, X., Voon, V., Jiang, Y., Lo, C.Z., Wang, L., et al. (2023) Neurophysiological Stratification of Major Depressive Disorder by Distinct Trajectories. Nature Mental Health, 1, 863-875. [Google Scholar] [CrossRef
[39] Chen, X., Dai, Z. and Lin, Y. (2023) Biotypes of Major Depressive Disorder Identified by a Multiview Clustering Framework. Journal of Affective Disorders, 329, 257-272. [Google Scholar] [CrossRef] [PubMed]
[40] Wu, P., Kong, L., Zhou, Y., Deng, C., Wang, Z., Shen, Y., et al. (2025) Neurobiological Subtypes of Adolescent Depression: A Multimodal Integration of Morphometric Similarity Network and Spatial Transcriptomics. Molecular Psychiatry, 30, 5448-5462. [Google Scholar] [CrossRef] [PubMed]