Brainwide Functional Connectivity Alterations in Major Depressive Disorder and Baseline Correlates of Treatment Response.

BACKGROUND

Major depressive disorder (MDD) has been linked to altered resting-state functional connectivity between the default mode, salience, and task-positive networks. In this study, we aimed to identify resting-state networks with potential utility for distinguishing patients with MDD from healthy control (HC) participants and treatment responders from nonresponders.

METHODS

A total of 108 unmedicated patients with moderate-to-severe MDD (ages 15-25 years; 67 female) and 100 HC participants (ages 15-25 years; 55 female) underwent a 3T resting-state functional magnetic resonance imaging scan. Patients were randomized to receive cognitive behavioral therapy for 12 weeks plus either fluoxetine or placebo. Using whole-brain functional connectivity multivariate pattern analysis and post hoc seed-to-voxel analyses, we identified the brain networks containing at least 10% of classification-relevant information, their most important regions, and how their brainwide functional connectivity differs across groups.

RESULTS

Patients exhibited stronger negative connectivity between the default mode, salience, and dorsal attention networks. The strength of the negative connectivity between the default mode and salience network was associated with worse treatment response. Additionally, the visual network was informative for treatment response, showing weaker within-network positive connectivity in responders.

CONCLUSIONS

Our data-driven approach replicated findings of functional connectivity alterations between task-negative networks and both the salience and task-positive networks in MDD. These patterns, together with alterations within the ventral visual stream, were associated with treatment response. These network-level disruptions may align with impairments in top-down regulation of emotion, rumination, and mood-congruent bias that characterize MDD.