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Brain Imaging

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Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method

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Increased functional connectivity between brainstem substructures and cortex in treatment resistant depression.

Anastasia Gaspert¹, Rasmus Schülke¹, Zeinab Houjaije¹

¹Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.

Psychiatry Research. Neuroimaging

|February 5, 2025

Summary

Treatment-resistant depression (TRD) shows increased brainstem-to-cortex functional connectivity (FC) in the midbrain and pons. This altered FC correlates with depression severity, suggesting a link between brainstem changes and TRD symptoms.

Keywords:

Bayesian segmentation Brainstem Functional magnetic resonance imaging (fMRI)Resting-state functional connectivity Somatosensory cortex Treatment-resistant depression

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Area of Science:

Neuroimaging
Psychiatry
Brain Connectivity

Background:

Major depressive disorder is associated with abnormal brainstem-to-cortex functional connectivity (FC).
Few studies have investigated brainstem substructures in treatment-resistant depression (TRD).

Purpose of the Study:

To analyze resting-state seed-based FC between brainstem substructures (midbrain, pons, medulla oblongata) and cortical/subcortical regions in TRD patients.
To compare FC between TRD patients and healthy controls.
To assess the relationship between FC strength and depressive symptom severity in TRD.

Main Methods:

Resting-state functional magnetic resonance imaging (fMRI) was used.
Seed-based functional connectivity (FC) analysis was performed between brainstem regions and cortical/subcortical areas.
Group comparisons and correlation analyses with depressive symptom severity (BDI-II) were conducted.

Main Results:

Patients with TRD exhibited increased FC in the midbrain and pons to the precentral gyrus, postcentral gyrus, and temporal gyrus compared to healthy controls.
In TRD patients, midbrain-to-cortex FC was negatively correlated with BDI-II scores.

Conclusions:

Increased midbrain/pons-to-cortex FC is observed in patients with TRD.
Altered brainstem-to-cortex connectivity may be related to the pathophysiology and severity of TRD.
Further research with larger cohorts is needed to confirm these findings and explore causal relationships.