Electroconvulsive therapy modulates functional interactions between submodules of the emotion regulation network in major depressive disorder

Jinping Xu,Xun Yang,Zhengyu He,Kai Wang,Qingmao Hu,Qiang Wei,Lijie Wang,Jiaojian Wang,Chao Wang,Jianhuang Wu,Tongjian Bai,Yanghua Tian,Xuemei Li

doi:10.1038/s41398-020-00961-9

Abstract

An increasing number of neuroimaging studies have consistently revealed that disrupted functional interactions within the cognitive emotion regulation network (ERN) contribute to the onset of major depressive disorders (MDD). To disentangle the functional reorganization of ERN after electroconvulsive therapy (ECT) in MDD is curial for understanding its neuropathology. Resting-state functional magnetic resonance imaging data was collected from 23 MDD patients before and after ECT, as well as 25 healthy controls. Network modularity analysis was used to identify the submodules and functional connectivity (FC) was used to investigate the functional reorganization of ERN in the MDD patients after ECT. Four submodules of ERN were identified, including emotion response module (ERM), emotion integration module (EIM), emotion generation module (EGM), and emotion execution module (EEM). The increased intra-modular FC of EEM and inter-modular FCs of EEM with EIM\\ERM were found in MDD patients after ECT. Modular transition analysis revealed that left ventrolateral prefrontal cortex, supplementary motor area, posterior cingulate cortex, right angular gyrus, and right precentral gyrus were transferred across different submodules across the three groups. Further analyses showed correlations between changed FC and clinical symptoms in the MDD patients after ECT. Finally, we also identified 11 increased connections between nodes belonging to different submodules of ERN in MDD patients after ECT. These results showed that ECT could induce functional reorganization of intra- and inter-modules within the ERN, and the functional changes were related to therapeutic efficacy or memory impairments of ECT in MDD patients.

Highlights

Major depressive disorder (MDD) is a common psychiatric disorder that is characterized by cognitive deficits and affective symptoms[1], with a lifetime prevalence ~15%2
For the identified four submodules within emotion regulation network (ERN), the intra-functional connectivity (FC) of execution module (EEM), inter-FC between emotion integration module (EIM) and EEM, inter-FC between emotion response module (ERM) and EEM, as well as 11 inter-FC between regions belonging to different modules were found to increase in MDD patients after electroconvulsive therapy (ECT)
Most brain regions were stably located in the same module, the ventrolateral prefrontal cortex (VLPFC).L, supplementary motor area (SMA), PCC, angular gyrus (AG).R, and PreCG.R were found to transfer between different modules across the three groups

Summary

Introduction

Major depressive disorder (MDD) is a common psychiatric disorder that is characterized by cognitive deficits and affective symptoms[1], with a lifetime prevalence ~15%2. Emotion regulation is widely thought to include five subcomponents processes: selection of the situation, modification of the situation, deployment of attention, change of cognitions, and modulation of response[11,12]. This perspective on emotion regulation treats the nervous. On the basis of appraisal theories of emotion, Kohn et al.[13] proposed a three-stage cognitive emotion regulation, including the affective evaluation, initiation of regulation, and execution of regulation. To delineate the hierarchical topographies of subprocesses and their interconnections of ERN could greatly facilitate our understanding of neuropathological basis of dysfunctions of emotion regulation in MDD and better identify the mechanism of treatment response

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