Association between social withdrawal and suicidal ideation in patients with major depressive disorder: The mediational role of emotional symptoms.

BACKGROUND: The study was designed to investigate the associations between social withdrawal, emotional symptoms, and suicide ideation in patients with major depressive disorder (MDD). METHODS: This cross-sectional study included 2678 MDD patients from the National Survey on Symptomatology of Depression (NSSD). Differences in the sociodemographic factors, clinical characteristics, suicide ideation, and emotional symptoms were compared in patients with different frequencies of social withdrawal. Pearson correlation, multiple linear regression analysis, and mediation analysis were employed to assess the contribution of social withdrawal to suicide ideation. RESULTS: MDD patients with a higher frequency of social withdrawal were prone to have a higher frequency of suicide ideation (p for trend <0.001) and history of suicide behavior (p for trend <0.001). Multiple linear regression analysis showed that there was a dose-response relationship between social withdrawal and suicide ideation in MDD patients, but this association became insignificant after adjusting for emotional symptoms. Mediation analysis suggested that all of the emotional symptoms had significant mediating effects on the association between social withdrawal and suicide ideation in MDD patients (p < 0.05). The magnitude of mediation varied between 4.3 % and 64.3 %, with the largest mediating effect in the feeling of despair (64.3 %), helplessness (41.2 %), and loneliness (40.0 %). CONCLUSION: Our study provides evidence that social withdrawal was a common clinical presentation and it may increase the risk for suicide through emotional symptoms in MDD patients. LIMITATIONS: Causal conclusions could not be drawn between social withdrawal, emotional symptoms, and suicide ideation because of the cross-sectional design of the study.

Associations between gastrointestinal symptoms, medication use, and spontaneous drug discontinuation in patients with major depressive disorder in China.

BACKGROUND: The study was designed to investigate the associations between gastrointestinal (GI) symptoms, medication use, and spontaneous drug discontinuation (SDD) in patients with major depressive disorder (MDD). METHODS: This cross-sectional study included 3256 MDD patients from the National Survey on Symptomatology of Depression (NSSD). Differences in the sociodemographic factors, clinical characteristics, medication use, and self-reported reasons for SDD were compared in patients with different frequencies of GI symptoms. A multiple logistic regression analysis was employed to assess the contribution of GI symptoms to the risk of spontaneous drug discontinuation. RESULTS: MDD patients with a higher frequency of GI symptoms were prone to have higher proportions of mood stabilizer and benzodiazepine uses (ps for trend < 0.001) but a lower proportion of SNRI use (pfor trend < 0.001). With the increase in GI symptoms, patients were prone to report worries about long-term side effects (pfor trend < 0.001), with the patients stating ineffective treatments (pfor trend = 0.002) and intolerance of adverse drug reactions (pfor trend = 0.022) as the reasons for SDD. Compared with those patients without GI symptoms, all of the MDD patients with GI symptom frequencies of several days (OR = 1.317; 95 % CI: 1.045-1.660), more than half of all days (OR = 1.305; 95 % CI: 1.005-1.695), and nearly every day (OR = 1.820; 95 %: 1.309-2.531) had an increased risk of SDD. CONCLUSION: GI symptoms are highly associated with drug discontinuation in MDD patients. These findings may have important implications for clinical treatment options, as well as for drug adherence management, in MDD patients.

Correction to: Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications (Neuroscience Bulletin, (2021), 37, 6, (863-880), 10.1007/s12264-021-00638-3) / 神经科学通报·英文版

A correction to this paper has been published: https://doi.org/10.1007/s12264-021-00694-9.

Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications / 神经科学通报·英文版

Major depressive disorder (MDD), also referred to as depression, is one of the most common psychiatric disorders with a high economic burden. The etiology of depression is still not clear, but it is generally believed that MDD is a multifactorial disease caused by the interaction of social, psychological, and biological aspects. Therefore, there is no exact pathological theory that can independently explain its pathogenesis, involving genetics, neurobiology, and neuroimaging. At present, there are many treatment measures for patients with depression, including drug therapy, psychotherapy, and neuromodulation technology. In recent years, great progress has been made in the development of new antidepressants, some of which have been applied in the clinic. This article mainly reviews the research progress, pathogenesis, and treatment of MDD.

Hypothalamic-Pituitary-End-Organ Axes: Hormone Function in Female Patients with Major Depressive Disorder / 神经科学通报·英文版

Classic hypothalamic-pituitary-end-organ feedback loops – the hypothalamic-pituitary-adrenal axis (HPAA), hypothalamic-pituitary-thyroidal axis (HPTA), and hypothalamic-pituitary-gonadal axis (HPGA) – are associated with the neuroendocrine and immune systems in major depressive disorder (MDD). Female patients with MDD present with evident neuroendocrine and immunological changes. Glucocorticoid, thyroid hormone, and reproductive steroid levels fluctuate with menstrual cycles, which might lead to glucocorticoid receptor resistance, impairment of triiodothyronine conversion, and sex hormone secretion disorders. In this review, we summarize the independent and interactive functions of these three axes in female MDD patients. The similar molecular structure of steroids implies an interrelationship between the hypothalamic-pituitary-end-organ axes and the competitive inhibitory effects at the receptor level, especially when considering the HPAA and HPGA.

Relationship among depression,anxiety and social support in elderly patients from community outpa-tient clinic / 中华行为医学与脑科学杂志

Objective To explore the relationship among depression,anxiety and social support in elderly patients in community outpatient clinic. Methods A total of 551 elderly outpatients from two com-munity health service centers of Hongkou District in Shanghai were evaluated with patient health question-naire-9 (PHQ-9),generalized anxiety disorder-7 (GAD-7),perceived social support scale( PSSS) for de-pression,anxiety,physical health and social support. Results The prevalence rates of depression and anxiety were 26. 1% and 17. 2%,respectively. The scores of PHQ-9 and GAD-7 were 2. 0(4. 0) and 1. 0(2. 0). There were statistically significant differences in the scores of family support,friend support,other support and social support among the elderly patients with different degrees of depression or anxiety (P<0. 01). Fam-ily support(B=-0. 196) and friend support(B=-0. 171) were protective factors of depression in elderly pa-tients in community outpatient clinic. Age,family support and friend support were protective factors of anxiety in elderly patients,while gender and fluctuation of physical diseases were protective factors of anxiety(P<0. 05). Con-clusions The depression and anxiety is intimately related to social support in elderly outpatients. Appropriate measures should be taken to optimize social support,mitigate bad mood negative improve their quality of life.

Response Inhibition and Emotional Regulation in the Patients with Attention-Deficit/Hyperactivity Disorder and Comorbidity of Disruptive, Impulse-Control, and Conduct Disorders

No abstract available.

The Relationship Between Neuroimmunity and Bipolar Disorder: Mechanism and Translational Application / 神经科学通报·英文版

Neuroimmune system may be involved in the pathological process of bipolar disorder (BD), but the essential association is not fully understood. Accumulating evidence has shown that BD involves the activation of immune cells and the release of inflammatory substances in the central nerve system (CNS). Meanwhile, neuroimmune responses also interact with other hypothesis of the etiology of BD that are widely recognized, such as neurotransmitter systems, neuroendocrine systems, neurotrophic factors, and oxidative stress. Simultaneously, related genes and immune changes in peripheral blood vary with it. Overall, neuroimmunity may play an important role in the pathogenesis of BD, and the inflammatory cytokines, especially interleukin-6 and tumor necrosis factor-alpha, have potential value for the clinical diagnosis and prognosis of BD, as well as predicting the therapeutic effects of drugs. Large-scale studies are needed to extend the evidence on neuroimmunity in BD, and to examine its clinical value for applications such as early prediction and treatment.

Effect of mood stabilizer on gray matter volume in patients with bipolar disorder Ⅰ / 中华行为医学与脑科学杂志

Objective To investigate the abnormal change of gray matter volume in patients with euthymic bipolar disorder Ⅰ (BD-Ⅰ),and to elucidate the relationship between the use of different mood stabilizers and brain structure variations.Methods Voxel-based morphometry (VBM) was used to analyze the volume of local gray matter in 35 patients with BD-Ⅰ and 30 healthy controls(HC).The patients were divided into BD-Ⅰ with lithium group and BD-Ⅰ with valproate group according to different mood stabilizers.The volume differences of gray matter of the three groups were compared by one-way ANOVA.Results Compared with HC,BD-Ⅰ patients showed significantly reduced gray matter volume in the medial frontal cortex (MNI (x,y,z):2,34,-18),orbital frontal cortex (MNI(x,y,z):-32,22,-4),frontal operculum (MNI(x,y,z):38,18,4) and insula cortex (MNI(x,y,z):-32,22,-4) (P＜0.05).There was no significant difference in thevolume of gray matter between BD-Ⅰ with lithium group and BD-Ⅰ with valproate group(P＞0.05).Conclusion Emotional disturbance in patients with BD-Ⅰ may be associated with reduced gray matter volume in the medial frontal cortex,orbital frontal cortex,frontal operculum and insula cortex.There are not significant difference about the effects of lithium carbonate and valproate on cerebral gray matter volume in patients with BD-Ⅰ.

Advances in neuroimaging studies on executive impairment of patients with euthymic bipolar disorder / 上海交通大学学报（医学版）

Bipolar disorder (BD) is a chronic mental illness with high recurrence rate and disability. As one of the core symptoms, cognitive impairment may occurs at every stage of the disease. Evidence from the neuroimaging studies revealed that the abnormal brain volumes, the blood flow and oxygen saturation of key brain areas are related to executive impairment in patients with bipolar disorder. This article reviews current structural and functional neuroimaging studies about the executive impairment of patients with euthymic bipolar disorder and research progresses.

Attempted suicide risk factors in major depressive disorder patients with atypical features / 中国神经精神疾病杂志

Objective To explore the attempted suicide risk factors of socio-demographic and clinical charac-teristics in major depressive disorder patients with atypical features (e.g. increased appetite, weight gain and greater time spent sleeping). Methods This was a secondary analysis of the data from the Diagnostic Assessment Service for People with Bipolar Disorders in China (DASP), which was initiated by the Chinese Society of Psychiatry (CSP) and carried out in 13 major mental health centers in China. Totally 179 patients were diagnosed as atypical major depres-sive disorder patients in all 1172 major depressive disorder patients using Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-Ⅳ) by psychiatrists. Suicide attempters and nonattempters were grouped base on the interview results of suicidality module of the Mini International Neuro-psychiatric Interview (MINI). Multiple logistic regression were used to assess association between independent variables and attempted suicide in major depressive disorder patients with atypical features. Results The rater of attempted snicide was 23.5% (42/179) of atypical major depressive disorder patients reported prior or current attempted suicide. Compared to nonattempters, attempters had higher levels of suicidal ideation, postpartum depressive episodes, and the use of antipsychotic, mood stabilizers and benzodiazepines (P<0.05). Logistic regression analysis showed that number of admissions (OR=1.73, 95% CI: 1.093~2.740) and depressive episodes with suicidal ideation (OR=3.90, 95%CI: 1.506~10.092) were significantly associat-ed with attempted suicide in atypical unipolar depression patients (P<0.05). Conclusions High number of admissions and high levels of suicidal ideation may be considered as potential risk factors to identify atypical unipolar depression patients at risk for future suicidal behavior.

Risk factors of anxious symptoms in patients with bipolar disorder / 中华行为医学与脑科学杂志

Objective To analyze the risk factors of socio-demographic and clinical characteristics related to anxious symptoms in bipolar depression patients(BDP).Methods This was a secondary analysis of data from the Diagnostic Assessment Service for People with Bipolar Depression in China(DASP)from September 1,2010 to February 28,2011.According to the criterion that comorbid anxiety or not, BDP(n=306)were divided into comorbid anxiety group(n =200)(65.4％)and without anxiety group(n =106)(34.6％).Further analysis for risk factors of anxious symptoms in BDP was performed by the multivariate logistic regression analysis.Results BDP with anxiety were younger(35.10± 11.09), younger at illness onset(27.93-± 10.04), ruore male(t =4.603, P＜0.05), more lifetime episodes(3.21 ± 3.77), frequently episodes(t =17.328,P＜0.05),inducement onset(t=14.859,P＜0.05)and more seasonal episodes(t=8.300,P＜0.05)compared with BDP without anxiety.Logistic regression analysis showed that inducement onset(OR=5.023)and episodes frequency(OR=10.852)was significantly associated with anxious symptom(P＜0.05).Conclusion The finding indicates that postpartum onset and depressive episodes frequency may be risk factors of bipolar depression with anxiety.

Risk factors of anxious symptoms in patients with bipolar disorder / 中华行为医学与脑科学杂志

Objective To analyze the risk factors of socio-demographic and clinical characteristics related to anxious symptoms in bipolar depression patients(BDP).Methods This was a secondary analysis of data from the Diagnostic Assessment Service for People with Bipolar Depression in China(DASP)from September 1,2010 to February 28,2011.According to the criterion that comorbid anxiety or not, BDP(n=306)were divided into comorbid anxiety group(n =200)(65.4％)and without anxiety group(n =106)(34.6％).Further analysis for risk factors of anxious symptoms in BDP was performed by the multivariate logistic regression analysis.Results BDP with anxiety were younger(35.10± 11.09), younger at illness onset(27.93-± 10.04), ruore male(t =4.603, P＜0.05), more lifetime episodes(3.21 ± 3.77), frequently episodes(t =17.328,P＜0.05),inducement onset(t=14.859,P＜0.05)and more seasonal episodes(t=8.300,P＜0.05)compared with BDP without anxiety.Logistic regression analysis showed that inducement onset(OR=5.023)and episodes frequency(OR=10.852)was significantly associated with anxious symptom(P＜0.05).Conclusion The finding indicates that postpartum onset and depressive episodes frequency may be risk factors of bipolar depression with anxiety.

Analyses of vitamin D2/D3 levels in moderately and severely depressive patients / 上海交通大学学报（医学版）

Objective · To detect the vitamin D2 and D3 levels in the patients with moderate and severe depression. Methods · Eighty-five patientswho met the criteria for major depressive disorder were recruited (53 patients with moderate depression, 32 patients with severe depression). Fifty agematchedhealthy volunteers were recruited as controls. Serum 25 (OH) D2, 25 (OH) D3 and total 25 (OH) D2/D3 levels were detected by using liquidchromatography-tandem mass spectrometry (LC-MS/MS). The risk factors which might influence the severity of depression were screened by Logisticregression analysis. Results · The serum 25 (OH) D2, 25 (OH) D3 and total 25 (OH) D2/D3 levels in the case group was lower than those in the controlgroup (P=0.012, P=0.000, P=0.000). The patients with moderate depression presented significantly lower serum 25 (OH) D3 and total 25 (OH) D2/D3 levelsthan the controls did (P=0.000), although no significant difference in serum 25 (OH) D2 levels was found between these two groups. As well, the serum 25 (OH) D2, 25 (OH) D3 and total 25 (OH) D2/D3 levels in patients with severe depression were significantly lower than those in patients with moderate depression and controls (P<0.05). The body mass index of severe depression group was much higher than that of moderate depression group and control group (P=0.002). Both overweight/obesity and the concentration of vitamin D may be the major influencing factors of depression severity (P=0.034, P=0.011). Conclusion · Vitamin D2 and D3 deficiency in depressive patients, particularly in those patients with severe depression, was shown in the present study. In addition, overweight/obesity as well as the concentration of vitamin D may exert the significant influence on the severity of depression. Vitamin D supplementation and weight control may be needed to be considered in making therapeutic strategies of major depressive disorder.

Comparative study of clinical features between different subtype bipolar patients with first mania episode / 上海交通大学学报（医学版）

Objective·To compare the clinical features between different subtype bipolar patients with first mania episode, and to contribute to early identification of bipolar disorder. Methods·This study was based on the database named as National Bipolar Mania Pathway Survey (BIPAS). From November 2012 to January 2013, bipolar patients from 26 mental health facilities in China were enrolled in current study. The clinical features were compared between mania patients of different subtypes, including hypomania (groupⅠ), mania without psychotic symptoms (groupⅡ), mania with psychotic symptoms (group Ⅲ) and mixed state (group Ⅳ). Results·There was significant difference in the percentage of clinical symptoms between different subtype bipolar patients with first mania episode, especially the mania and anxiety related symptoms. Group Ⅰ, Ⅲ , Ⅳ were further compared with groupⅡ, which was considered as the typical bipolar disorder. The results showed that the mania related symptoms was significantly higher in group Ⅱ, but anxiety related symptoms was significantly higher in group Ⅰ, Ⅲ, Ⅳ. Moreover, Logistic regression analysis revealed that more eloquent or humor and unusually restless could be in favor of the diagnosis of hypomania; younger and mania or hypomania as first episode might be in favor of the diagnosis of mania with psychotic symptoms; older, national minorities and unusually restless could be in favor of the diagnosis of mixed state. Conclusion·The clinical features between different subtype bipolar patients with first mania episode are various, and analysis of the clinical features can contribute to early identification of bipolar disorder.

Risk factors to suicide risk in misdiagnosed bipolar disorder II treated for major depressive disorder / 中国神经精神疾病杂志

Objective To analyze the risk factors of socio-demographic and clinical characteristics related to sui?cide risk in misdiagnosed bipolar disorderⅡ(BPⅡ) treated for major depressive disorder. Methods A total of l478 con?secutive major depressive disorder patients were interviewed with the Mini International Neuropsychiatric Interview (MINI) in 13 major mental health centers in China. Of the 1478 patients, 190 patients were diagnosed BPⅡ, who were divided into two groups (nonsuicidal risk and suicidal risk) with the suicidality module of MINI. Logistic regression was performed to evaluate significant risk factors associated with suicide risk in misdiagnosed BPⅡtreated for major depres?sive disorder. Results Of the 190 patients, 116 were in the nonsuicidal risk group and 74 were in the suicidal risk group. In comparison to the nonsuicidal risk group, the suicidal risk group had younger age [(34.45 ± 11.18) vs.(37.23 ± 13.22), P=0.008], earlier age at onset [(26.20 ± 9.16) vs. (30.37 ± 11.59), P=0.007], and more suicidal ideation (82.4%vs. 53.4%, P=0.001). Logistic regression analysis showed that age (OR=0.969,95% CI:0.945~0.993) and depressive epi?sodes with suicidal ideation (OR=4.129,95%CI:2.030~8.397) were significantly associated with suicide risk in patients of misdiagnosed BPⅡtreated for major depressive disorder (P<0.05). Conclusions Younger age, severer suicidal ide?ation may be potential independent risk factors to suicide risk in BPⅡwith misdiagnosed with major depressive disor?der.

Risk factors of suicidality in major depressive disorder patients with and without anxious characteristics / 中国心理卫生杂志

Objective:To compare the suicidality risk in major depressive disorder (MDD)patients with and without anxious characteristics,and analyze the risk factors of suicidality in MDD patients. Methods:This was a secondary analysis of the data from the Diagnostic Assessment Service for people with Bipolar Disorders in China (DASP),which was initiated by the Chinese Society of Psychiatry (CSP),from September 1,2010 to February 28, 201 1. Based on the anxious module and suicide module of Mini International Neuropsychiatric Interview (M. I. N. I),1 172 MDD patients were classified as suffering from anxious MDD (n=728,62. 1%)and non-anxious MDD(n=444,37. 9%). Logistic regression was employed to examine the risk factors of suicidality in MDD pa-tients. Results:Among the anxious MDD patients,331 (45. 5%)of them had suicidality risk. And 54(12. 2%)of non-anxious MDD patients had suicidality risk. Compare to the non-anxious group,the anxious MDD patients had significantly higher suicidality risk (P<0. 00 1 ). Logistic regression analysis showed that more frequent depressive episodes (OR=2. 07 ),depressive episodes with psychotic symptoms (OR=2. 0 1 ),comorbid with anxious charac-teristics (OR=3. 18)or melancholic characteristics (OR=2. 90)were associated with suicidality risk in patients with MDD. Conclusion:It indicates that the anxious MDD patients may have higher suicidality risk than non-anx-ious MDD patients,and more frequent depressive episodes,depressive episodes with psychotic symptoms,comorbid with anxious characteristics or melancholic characteristics may be risk factors of suicidality in patients with MDD.

Risk factors of suicidal attempt in major depressive disorder patients with anxious characteristics / 中国神经精神疾病杂志

Objective To analyze the risk factors of socio-demographic and clinical characteristics related to sui?cidal attempt in major depressive disorder (MDD) patients with anxious characteristics. Methods Based on the anxious module of Mini International Neuropsychiatric Interview (MINI), a total of 728 anxious MDD patients from 13 major men?tal health centers in China were classified as suicidal and non-suicidal attempt groups. Further analyses regarding risk factors of suicidal attempt in anxious MDD patients were performed by the multivariate logistic regression analysis. Re?sults Among the 728 patients with anxious MDD analyzed, 135 (18.5%) of them had suicidal attempt and 593 (81.5%) had non-suicidal attempt. Compared to the non-suicidal attempt group, patients with suicidal attempt had significantly earlier age onset[(32.3 ± 11.9) vs. (35.3 ± 13.1)], more lifetime depression episodes (median:2 vs. 2), more number of ad?missions (median: 1 vs. 0), more frequent depressive episodes (14.8% vs. 7.4%), more atypical characteristics (25.9%vs.15.0%), more suicidal ideation (78.5%vs. 50.3%) and more antidepressant use (81.5%vs. 71.2%). Logistic regression analysis showed that number of admissions (OR=1.18, 95%CI:1.02~1.37), frequent depressive episodes (OR=2.10, 95%CI:1.14~3.68), depressive episodes with suicidal ideation (OR=3.55, 95%CI:2.28~5.54) were associated with suicidal at?tempt in MDD patients with anxious characteristics (P<0.05). Conclusions More number of admissions, more frequent depressive episodes, comorbid suicidal ideation may be risk factors of suicidal attempt in anxious MDD patients.

Pharmacoeconomic comparisons of venlafaxine and mirtazapine in patients with treatment-resistant major depression / 中华行为医学与脑科学杂志

Objective To compare the cost-effectiveness and cost-utility of venlafaxine and mirtazapine in patients with treatment-resistant major depression (TRD).Methods One hundred and five patients with TRD were enrolled in this study and grouped into venlafaxine treatment (n=50) and mirtazapine treatment (n=55) based on the double-blind randomization scheme generated by computer.The treatment costs of antidepressants during 8 weeks were calculated,the rates of clinical response and remission were taken as treatment effectiveness,and the quality-adjusted life years (QALYs) as treatment utility.The descriptive analysis and nonparametric test were used to compare the cost-effectiveness and cost-utility of different groups.Results During 8 weeks,the treatment cost of antidepressant was ￥ 1 396.44 for venlafaxine and ￥ 1 206.90 mirtazapine,and the difference between two groups was ￥ 189.54.The cost-effectiveness ratios between venlafaxine and mirtazapine were very close (differed ￥ 0.06 for remission rate and ￥ 1.08 for response rate respectively).There was no significant difference for cost-utility ratios between two groups (physical functioning Z=-0.15,P＞0.05 ; mental health Z=-0.54,P＞0.05).Conclusion Both cost-effectiveness and cost-utility of venlafaxine in patients with TRD are close between venlafaxine and mirtazapine.

The study on the expression of the p-CREB in a rat model of chronic mild stress.WANG Lingxiao, PENG / 中国神经精神疾病杂志

Objective To better understand the role of CREB signaling pathway in chronic mild stress (CMS), we investigated the alteration of CREB and p-CREB in CMS rats with and without fluoxetine hydrochloride. Methods Fifty adult male Sprague-Dawley rats were randomly divided into three groups:CMS group (26), fluoxtine group (12) and con-trol group (12). The rats in CMS group and fluoxtine group received 8 weeks of chronic mild stress. Rats in fluoxtine group were administered daily injections of fluoxetine 10mg/kg I.P. Sucrose preference tests and open-field test were car-ried out after the 8th week. Based on endpoint sucrose-intake, animals were further divided into 4 groups:CMS sensitive group, CMS resilient group, fluoxtine group and control group. Western blot was used to detect the expression levels of CREB and p-CREB in the hippocampus and prefrontal cortex. Results The sucrose consumption was significantly de-creased in CMS resilience group compared to sensitive group, control group and fluoxetine-intervention group (all P<0.05). Similarly, the numbers in total arm entries, percentage of entries into open arms and time spent in open arms was significantly lower in CMS resilience group compared to control group(all P<0.05), but not different compared to CMS sensitive group(all P<0.05). The p-CREB in the hippocampus was significantly lower in CMS sensitive rat compared to CMS resilience group, control group and fluoxetine-intervention group(all P<0.05), but CREB was not dfferent among the four groups(all P<0.05). Conclusions The elevated phosphorylation of CREB in the hippocampus and prefrontal cortex of resilience CMS rats may contribute to the mood alteration induced by stress.