Abstract
Background: Melancholic depression has been viewed as one severe subtype of major depressive disorder (MDD). However, it is unclear whether melancholic depression has distinct changes in brain imaging. We aimed to explore specific or distinctive alterations in melancholic MDD and whether the alterations could be used to separate melancholic MDD from non-melancholic MDD or healthy controls.Materials and Methods: Thirty-one outpatients with melancholic MDD and thirty-three outpatients with non-melancholic MDD and thirty-two age- and gender-matched healthy controls were recruited. All participants were scanned by resting-state functional magnetic resonance imaging (fMRI). Imaging data were analyzed with the regional homogeneity (ReHo) and support vector machine (SVM) methods.Results: Melancholic MDD patients exhibited lower ReHo in the right superior occipital gyrus/middle occipital gyrus than non-melancholic MDD patients and healthy controls. Merely for non-melancholic MDD patients, decreased ReHo in the right middle frontal gyrus was negatively correlated with the total HRSD-17 scores. SVM analysis results showed that a combination of abnormal ReHo in the right fusiform gyrus/cerebellum Crus I and the right superior occipital gyrus/middle occipital gyrus exhibited the highest accuracy of 83.05% (49/59), with a sensitivity of 90.32% (28/31), and a specificity of 75.00% (21/28) for discriminating patients with melancholic MDD from patients with non-melancholic MDD. And a combination of abnormal ReHo in the right fusiform gyrus/cerebellum VI and left postcentral gyrus/precentral gyrus exhibited the highest accuracy of 98.41% (62/63), with a sensitivity of 96.77% (30/31), and a specificity of 100.00%(32/32) for separating patients with melancholic MDD from healthy controls.Conclusion: Our findings showed the distinctive ReHo pattern in patients with melancholic MDD and found brain area that may be associated with the pathophysiology of non-melancholic MDD. Potential imaging markers for discriminating melancholic MDD from non-melancholic MDD or healthy controls were reported.
Highlights
Major depressive disorder (MDD), a common, recurrent and disabling psychiatric disorder, severely leads to impaired psychosocial function and reduced quality of life [1]
Discriminating Patients With Melancholic MDD From Non-melancholic MDD The support vector machines (SVM) results showed that a combination of abnormal Regional homogeneity (ReHo) in the right fusiform gyrus/cerebellum Crus I and right superior occipital gyrus/middle occipital gyrus exhibited the highest accuracy of 83.05% (49/59), with a sensitivity of 90.32% (28/31), and a specificity of 75.00%(21/28) for discriminating patients with melancholic MDD from patients with non-melancholic MDD (Figures 5, 6)
The SVM analysis results showed that a combination of abnormal ReHo in the right fusiform gyrus/cerebellum Crus I and right superior occipital gyrus/middle occipital gyrus might be a potential imaging marker to separate melancholic MDD patients from non-melancholic MDD patients, and a combination of abnormal ReHo in the right fusiform gyrus/cerebellum VI and left postcentral gyrus/precentral gyrus might be a potential imaging marker to separate melancholic MDD patients from healthy controls
Summary
Major depressive disorder (MDD), a common, recurrent and disabling psychiatric disorder, severely leads to impaired psychosocial function and reduced quality of life [1]. Despite of the common features of MDD, melancholic depression is characterized by pervasive anhedonia, unremitting apprehension and morbid statements, blunted emotional response, non-reactive mood, retardation, spontaneous agitation, reduced concentration, and impaired working memory [3]. There is no consensus on whether melancholic depression is a categorically separate psychiatric disorder or a dimensionally severe subtype of MDD [4, 5], poorer cognitive performance was observed in melancholic MDD than nonmelancholic MDD, in visual learning and executive functions, like attention/working memory, reasoning/problem solving and processing speed [6, 7]. Melancholic depression has been viewed as one severe subtype of major depressive disorder (MDD). It is unclear whether melancholic depression has distinct changes in brain imaging. We aimed to explore specific or distinctive alterations in melancholic MDD and whether the alterations could be used to separate melancholic MDD from non-melancholic MDD or healthy controls
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