非典型抑郁症患者睡眠紊乱的研究进展

doi:10.3969/j.issn.1674-8115.2026.02.014

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (2): 241-247.doi: 10.3969/j.issn.1674-8115.2026.02.014

• 综述 • 上一篇

非典型抑郁症患者睡眠紊乱的研究进展

方雯¹, 张浩楠¹, 杨涛¹, 陈俊²(), 方贻儒³^,⁴

^1.上海交通大学医学院附属精神卫生中心精神科，上海 200030
^2.上海交通大学医学院附属精神卫生中心临床研究中心/心境障碍科，上海 200030
^3.上海交通大学医学院附属瑞金医院情感障碍中心/精神心理科，上海 200025
^4.上海交通大学医学院精神与临床心理学院，上海 200025

收稿日期:2025-05-09 接受日期:2025-05-12 出版日期:2026-02-28 发布日期:2026-02-28
通讯作者: 陈俊，主任医师，博士；电子信箱：doctorcj2010@gmail.com。
基金资助:
国家自然科学基金(82471554)

Research progress of sleep disturbance in patients with atypical depression

Fang Wen¹, Zhang Haonan¹, Yang Tao¹, Chen Jun²(), Fang Yiru³^,⁴

^1.Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
^2.Clinical Research Center/Department of Affective Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
^3.Affective Disorders Center/Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
^4.College of Psychiatry and Clinical Psychology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received:2025-05-09 Accepted:2025-05-12 Online:2026-02-28 Published:2026-02-28
Contact: Chen Jun, E-mail: doctorcj2010@gmail.com.
Supported by:
National Natural Science Foundation of China(82471554)

摘要/Abstract

摘要：

非典型抑郁症（atypical depression，AD）是一种以情绪反应、过度睡眠、食欲增加及人际敏感为特征的抑郁症亚型。AD患者过度睡眠的发生率显著高于典型抑郁症，患者存在总睡眠时间延长、睡眠质量差、睡眠结构异常等特征，且与病程延长、复发风险增大及治疗反应差密切相关。神经递质失衡、炎症因子增多及下丘脑-垂体-肾上腺轴紊乱等可能是与睡眠紊乱相关AD的核心病理机制。目前AD的诊断工具存在缺陷，需结合该病的睡眠紊乱特征、生物标志物以及神经影像学表现等优化诊断方法。AD睡眠紊乱在症状、发病机制以及治疗等方面具有复杂性和异质性，需要通过跨学科的整合协作进行深入研究。该文对AD睡眠紊乱的临床特征、病理机制及现有治疗策略等进行综述。

关键词: 非典型抑郁症, 睡眠紊乱, 临床特征, 病理机制, 治疗策略

Abstract:

Atypical depression (AD) is a subtype of depression characterized by emotional reactivity, excessive sleep, increased appetite, and interpersonal sensitivity. The prevalence of excessive sleep in AD patients is significantly higher than that in patients with typical depression. Patients have characteristics such as prolonged total sleep time, poor sleep quality, and abnormal sleep structure, which are closely related to prolongation of the disease course, increased risk of recurrence, and poor treatment response. Imbalances in neurotransmitters, elevation of inflammatory factors, and disorders of the hypothalamic-pituitary-adrenal axis are considered core pathological mechanisms related to sleep disturbance in AD. Existing diagnostic tools for AD have deficiencies, thus necessitating the integration of sleep disturbance characteristics, biomarkers, and neuroimaging findings to optimize diagnostic strategies. Given the complexity and heterogeneity of AD-related sleep disturbance in terms of clinical manifestations, pathogenesis, and treatment, in-depth research requires interdisciplinary integration and collaboration. This article reviews the clinical features, pathological mechanisms, and current treatment strategies of sleep disturbances in atypical depression.

Key words: atypical depression (AD), sleep disturbance, clinical features, pathological mechanisms, treatment strategies

中图分类号:

R749.4

方雯, 张浩楠, 杨涛, 陈俊, 方贻儒. 非典型抑郁症患者睡眠紊乱的研究进展[J]. 上海交通大学学报（医学版）, 2026, 46(2): 241-247.

Fang Wen, Zhang Haonan, Yang Tao, Chen Jun, Fang Yiru. Research progress of sleep disturbance in patients with atypical depression[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(2): 241-247.

参考文献 39

[1]	American Psychiatric Association. Diagnostic and statistical manual of mental disorders[M]. 5th ed. Arlington: American Psychiatric Association, 2013.
[2]	Brailean A, Curtis J, Davis K, et al. Characteristics, comorbidities, and correlates of atypical depression: evidence from the UK Biobank Mental Health Survey[J]. Psychol Med, 2020, 50(7): 1129-1138.
[3]	Cheung M M S, Lam S P, Chau S W H, et al. Hypersomnolence is associated with non-remission of major depressive disorder[J]. Sleep Med, 2024, 119: 35-43.
[4]	Hein M, Lanquart J P, Loas G, et al. Prevalence and risk factors of excessive daytime sleepiness in major depression: a study with 703 individuals referred for polysomnography[J]. J Affect Disord, 2019, 243: 23-32.
[5]	Chen Y, Zhang L F, Hu S F, et al. Status and correlates of hypersomnia in hospitalized patients with unipolar depression: Beijing, Henan, and Shandong, China, August 2019‒March 2021[J]. China CDC Week, 2021, 3(42): 879-882.
[6]	Bhachech H, Nath K, Sidana R, et al. Personalized approach in the management of difficult-to-treat and treatment-resistant depression with second-generation antipsychotics: a Delphi statement[J]. Cureus, 2024, 16(1): e52878.
[7]	Pearson O, Uglik-Marucha N, Miskowiak K W, et al. The relationship between sleep disturbance and cognitive impairment in mood disorders: a systematic review[J]. J Affect Disord, 2023, 327: 207-216.
[8]	Carey M G, Al-Zaiti S S, Dean G E, et al. Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters[J]. J Occup Environ Med, 2011, 53(8): 928-933.
[9]	Rethorst C D, Greer T L, Toups M P, et al. IL-1β and BDNF are associated with improvement in hypersomnia but not insomnia following exercise in major depressive disorder[J]. Transl Psychiatry, 2015, 5(8): e611.
[10]	Sunderajan P, Gaynes B N, Wisniewski S R, et al. Insomnia in patients with depression: a STAR*D report[J]. CNS Spectr, 2010, 15(6): 394-404.
[11]	Kwaśna J, Kwaśny A, Wilkowska A, et al. Residual hypersomnia in unipolar and bipolar depression: a systematic review[J]. World J Biol Psychiatry, 2024, 25(10): 575-591.
[12]	Manwaring J L, Blalock D V, Duffy A, et al. An examination of adults with atypical anorexia nervosa at admission to treatment at higher levels of care: an attempt to increase diagnostic clarity[J]. Int J Eat Disord, 2024, 57(4): 848-858.
[13]	Antonietta Furio M, Popovic D, Vieta E, et al. Characterization of rapid cycling bipolar patients presenting with major depressive episode within the BRIDGE-Ⅱ-MIX study[J]. Bipolar Disord, 2021, 23(4): 391-399.
[14]	Thase M E. Atypical depression: useful concept, but it's time to revise the DSM-Ⅳ criteria[J]. Neuropsychopharmacology, 2009, 34(13): 2633-2641.
[15]	Scott J, Byrne E, Medland S, et al. Short communication: self-reported sleep-wake disturbances preceding onset of full-threshold mood and/or psychotic syndromes in community residing adolescents and young adults[J]. J Affect Disord, 2020, 277: 592-595.
[16]	Rumble M E, White K H, Benca R M. Sleep disturbances in mood disorders[J]. Psychiatr Clin N Am, 2015, 38(4): 743-759.
[17]	Pandi-Perumal S R, Monti J M, Burman D, et al. Clarifying the role of sleep in depression: a narrative review[J]. Psychiatry Res, 2020, 291: 113239.
[18]	Fornaro M, Caiazza C, Pistone L, et al. Atypical depression and emotion dysregulation: clinical and psychopathological features[J]. J Affect Disord, 2025, 376: 410-421.
[19]	Magen E L, Geishin A, Weizman A, et al. High rates of mood disorders in patients with chronic idiopathic eosinopenia[J]. Brain Behav Immun Health, 2024, 40: 100847.
[20]	Belanger H G, Lee C, Poliacoff Z, et al. Early response to antidepressant medications in adults with major depressive disorder: a naturalistic study and odds of remission at 14 weeks[J]. J Clin Psychopharmacol, 2023, 43(1): 46-54.
[21]	Spanagel R, Pendyala G, Abarca C, et al. The clock gene Per2 influences the glutamatergic system and modulates alcohol consumption[J]. Nat Med, 2005, 11(1): 35-42.
[22]	Olivier B, Olivier J D A. Efficacy, safety, and tolerability of psychedelics in treatment-resistant depression (TRD)[M]//Kim Y K.Recent advances and challenges in the treatment of major depressive disorder. Singapore: Springer Nature Singapore, 2024: 49-66.
[23]	Milaneschi Y, Lamers F, Berk M, et al. Depression heterogeneity and its biological underpinnings: toward immunometabolic depression[J]. Biol Psychiatry, 2020, 88(5): 369-380.
[24]	Refisch A, Sen Z D, Klassert T E, et al. Microbiome and immuno-metabolic dysregulation in patients with major depressive disorder with atypical clinical presentation[J]. Neuropharmacology, 2023, 235: 109568.
[25]	Chae W R, Baumert J, Nübel J, et al. Associations between individual depressive symptoms and immunometabolic characteristics in major depression[J]. Eur Neuropsychopharmacol, 2023, 71: 25-40.
[26]	Applewhite B, Penninx B W J H, Young A H, et al. The effect of a low-calorie diet on depressive symptoms in individuals with overweight or obesity: a systematic review and meta-analysis of interventional studies[J]. Psychol Med, 2024, 54(8): 1671-1683.
[27]	Adewuya A O, Coker O A, Atilola O, et al. Gender difference in the point prevalence, symptoms, comorbidity, and correlates of depression: findings from the Lagos State Mental Health Survey (LSMHS), Nigeria[J]. Arch Women's Ment Health, 2018, 21(6): 591-599.
[28]	Kim J H, Cho M J, Hong J P, et al. Gender differences in depressive symptom profile: results from nationwide general population surveys in Korea[J]. J Korean Med Sci, 2015, 30(11): 1659.
[29]	Tran K, Mcgill S C, Horton J. Bupropion for treatment-resistant depression[J]. Cjht, 2021, 1(4): 7-17.
[30]	Patarroyo-Rodriguez L, Pazdernik V, Vande Voort J L, et al. Hypersomnia as a predictor of response to intravenous ketamine/intranasal esketamine in treatment resistant depression[J]. J Affect Disord, 2024, 349: 272-276.
[31]	Badini I, Coleman J R I, Hagenaars S P, et al. Depression with atypical neurovegetative symptoms shares genetic predisposition with immuno-metabolic traits and alcohol consumption[J]. Psychol Med, 2022, 52(4): 726-736.
[32]	Younis I R, Gopalakrishnan M, Mathis M, et al. Association of end point definition and randomized clinical trial duration in clinical trials of schizophrenia medications[J]. JAMA Psychiatry, 2020, 77(10): 1064.
[33]	Robillard R, Carpenter J S, Feilds K L, et al. Parallel changes in mood and melatonin rhythm following an adjunctive multimodal chronobiological intervention with agomelatine in people with depression: a proof of concept open label study[J]. Front Psychiatry, 2018, 9: 624.
[34]	Geoffroy P A, Palagini L. Biological rhythms and chronotherapeutics in depression[J]. Prog Neuro Psychopharmacol Biol Psychiatry, 2021, 106: 110158.
[35]	Chung K F, Lee C T, Au C H, et al. Cognitive behavioural therapy for insomnia as an early intervention of mood disorders with comorbid insomnia: a randomized controlled trial[J]. Early Interv Psychiatry, 2024, 18(2): 82-93.
[36]	Tamaki K, Saito N, Tomita H. Serum 3-hydroxybutyrate is expected to serve as one of the supportive diagnostic markers of persistent idiopathic dentoalveolar pain (PDAP)[J]. J Pain Res, 2023, 16: 4005-4013.
[37]	Morita Y, Takahashi K, Ohshima S, et al. Is vestibular Meniere's disease associated with endolymphatic hydrops?[J]. Front Surg, 2020, 7: 601692.
[38]	Munagama C L, Rajendiran V, Silva S. A case report on a common tumour with an uncommon presentation: glioblastoma[J]. Cureus,2024, 16(8): e66830.
[39]	Said O, Stringer D, Sengun Filiz E, et al. Olanzapine for young PEople with aNorexia nervosa (OPEN): results of a feasibility study[J]. BMC Psychiatry, 2024, 24(1): 779.

非典型抑郁症患者睡眠紊乱的研究进展

Research progress of sleep disturbance in patients with atypical depression

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 39

相关文章 15

编辑推荐

Metrics

[1]	王博恩, 陈思远, 施晴, 张慕晨, 易红梅, 董磊, 王黎, 程澍, 许彭鹏, 赵维莅. 肾脏累及的弥漫性大B细胞淋巴瘤患者临床病理特征[J]. 上海交通大学学报（医学版）, 2024, 44(9): 1162-1168.
[2]	陈琼, 方杰, 魏强华. 系统性红斑狼疮合并纯红细胞再生障碍性贫血1例报道及文献复习[J]. 上海交通大学学报（医学版）, 2024, 44(2): 278-286.
[3]	陈子旋, 刘敏. 肾细胞癌舒尼替尼耐药性的机制及治疗研究进展[J]. 上海交通大学学报（医学版）, 2024, 44(10): 1307-1315.
[4]	赵洁, 姜言, 郝思国. 弥漫大B细胞淋巴瘤患者临床特征及预后分析[J]. 上海交通大学学报（医学版）, 2023, 43(10): 1282-1288.
[5]	丁思奇, 黄啸君, 詹飞霞, 田沃土, 曹立. ATP1A2基因突变所致的偏瘫型偏头痛2例报道[J]. 上海交通大学学报（医学版）, 2022, 42(8): 1158-1162.
[6]	谢依热·哈木拉提null, 赵倩, 李丞, 宋宁, 王颖, 古丽洁合热·吐尔逊null, 卜军, 杨毅宁, 李晓梅. 基于真实世界的缺血性心脑血管共患疾病的临床特征及卫生经济学评价[J]. 上海交通大学学报（医学版）, 2022, 42(6): 778-785.
[7]	胡佳宁, 张锦文, 刘晓瑞, 陈彩莲, 林羿. 难治性产后出血导致子宫切除的危险因素分析[J]. 上海交通大学学报（医学版）, 2022, 42(4): 409-414.
[8]	黄道, 韦栋, 徐志红, 胡家安. 老年呼吸道病毒感染119例临床特征分析[J]. 上海交通大学学报(医学版), 2021, 41(5): 628-631.
[9]	马银珠，陆光华，钟娜，王海红，和申，赵雪，江海峰，王振. 酒精所致精神病性障碍男性患者临床特征及危险因素[J]. 上海交通大学学报(医学版), 2020, 40(9): 1256-1262.
[10]	祖娟，钱方媛，吴迪，谢新欣，任庆国，张志珺. 成年晚发型糖原贮积症Ⅱ型临床特征及基因突变分析[J]. 上海交通大学学报(医学版), 2020, 40(8): 1108-1112.
[11]	曾素，许培培，郭明高. 具有乳头样核特征的非浸润性甲状腺滤泡性肿瘤的临床研究进展[J]. 上海交通大学学报(医学版), 2020, 40(7): 968-973.
[12]	吕娜，叶惠玲，范青#，肖泽萍#. 伴囤积症状强迫症患者的临床特征研究[J]. 上海交通大学学报(医学版), 2020, 40(6): 791-797.
[13]	管红艳，刘婧娴，刘瑛. 分离自血培养肺炎克雷伯菌的毒力基因及患者临床特征分析[J]. 上海交通大学学报（医学版）, 2020, 40(2): 235-.
[14]	姜涛 1, 2，施晴 1，许彭鹏 1，程澍 1，王黎 1，赵维莅 1. 肾上腺淋巴瘤临床病理特点及预后因素分析[J]. 上海交通大学学报（医学版）, 2019, 39(9): 1032-.
[15]	尚嘉伟 1，刘溪 2，李颖川 3，王爱忠 1. Toll样受体4在脂肪栓塞小鼠模型中的表达及对预后影响的研究[J]. 上海交通大学学报（医学版）, 2019, 39(4): 342-.