Changes In Brain Function In Patients With Major Depressive Disorders With Anxiety Symptoms: A FMRI Study

Objective:Major depressive disorder(MDD)is one of the most common mood disorders and is characterized by high prevalence,high relapse rate,and high economic burden on individuals,families,and society.MDD is often accompanied by anxiety symptoms,which leads to lower remission rates,higher rates of suicide,and poorer prognosis.Therefore,it is necessary to further investigate the pathogenesis of MDD with anxiety symptoms.With the advantages of non-invasive and multiple repeatable acquisitions,magnetic resonance imaging(MRI)technology is widely used in the study of brain structure and function in psychiatric disorders.It is widely used in the study of brain function in psychiatric disorders.This study investigates the neuroimaging characteristics of MDD patients with anxiety symptoms based on resting-state functional magnetic resonance imaging(rs-f MRI),which is expected to provide new ideas for the precise diagnosis and treatment of MDD.Methods:A total of 57 patients with first-onset MDD,as well as 30 healthy controls,were collected from 2016 to 2021 according to the inclusion and exclusion criteria,and patients with first-onset MDDs were assessed for anxiety symptoms using the Hamilton Anxiety Scale(HAMA),and MDDs were divided into the MDD with anxiety symptoms group(MDD-A)and MDD without anxiety symptoms group(MDD-NA)according to whether the HAMA score was greater than or equal to 14.A total of 28 MDD-A and 29MDD-NA and 30 HC were collected,and general information such as age,gender,and education was collected using a CRF,and all subjects were scanned with rs-f MRI.(1)General demographic data and clinical characteristicsOne-way ANOVA was used for age and education,chi-square test was used for gender,and two-sample t-test was used for HAMD-17 and HAMA.(2)Fractional Amplitude of Low Frequency FluctuationsThe fractional Amplitude of Low Frequency Fluctuations(f ALFF)was used as an index,and an analysis of covariance,followed by a post hoc test using Fisher’s least significant difference test(LSD),was used to derive the results of the two-by-two comparison between the three groups,and finally corrected using the Gaussian random field theory correction(GRF)method,with P<0.05 being statistically significant to identify MDD-A,MDD-NA,and HC brain regions with differences in f ALFF between them.(3)Regional HomogeneityRegional homogeneity(Re Ho)was used as an index,and analysis of covariance,followed by post hoc tests using LSD,yielded results for two-by-two comparisons between the 3 groups,and finally corrected by GRF,with P < 0.05 considered statistically significant to identify brain regions with differences in Re Ho between MDD-A,MDD-NA,and HC.(4)Functional ConnectivityBrain regions with differences in f ALFF between MDD-A and MDD-NA were extracted as regions of interest,and whole brain resting state functional connectivity(FC)was done,again using analysis of covariance,followed by post hoc tests using LSD to derive two-by-two comparisons between the 3 groups,and finally corrected using GRF,with P < 0.05 being statistically significant to derive MDD-A,MDD-NA and brain regions with differential functional connectivity between HC.Results:(1)General demographic data and clinical characteristicsThere were no statistically significant differences in age(F=2.226,P=0.114),gender(F=1.572,P=0.416),or education(F=1.824,P=0.168)between the three groups,and there were statistically significant differences between MDD-A and MDD-NA for HAMD-17(t=2.419,P=0.019),HAMA(t=12.571,P<0.001)were statistically different.(2)Fractional Amplitude of Low Frequency FluctuationsThere was a difference in f ALFF between the 3 groups in the left fusiform gyrus and left parahippocampal gyrus(P<0.05).Both MDD-A and MDD-NA had reduced f ALFF in the bilateral fusiform gyrus compared with HC(P<0.05).MDD-A had reduced f ALFF in the left parahippocampal gyrus compared to MDD-NA(P<0.05).(3)Regional HomogeneityThere was a difference in left paracentral lobule Re Ho between the 3 groups(P<0.05).Compared to HC,both MDD-A and MDD-NA had increased left paracentral lobule Re Ho and decreased left fusiform gyrus Re Ho in MDD-A and decreased right fusiform gyrus Re Ho in MDD-NA(P<0.05).The right caudate nucleus Re Ho was increased in MDD-A compared to MDD-NA(P<0.05).(4)Functional ConnectivityThere were differences in the functional connectivity of the bilateral orbitofrontal middle gyrus between the 3 groups(P<0.05).The FC of the right postcentral gyrus was reduced in MDD-A and MDD-NA compared to HC(P < 0.05).The functional connectivity of the orbitofrontal middle gyrus was increased bilaterally in MDD-A compared to MDD-NA(P<0.05).Conclusion:The present study found alterations in functional brain imaging between major depressive disorders with anxiety symptoms and major depressive disorders without anxiety symptoms,mainly involving the parahippocampal gyrus,the fusiform gyrus,the orbitofrontal middle gyrus,and the caudate nucleus.Major depressive disorder with anxiety symptoms,as one of the subtypes of major depressive disorders,has different neuroimaging mechanisms than major depressive disorders without anxiety symptoms.