Energy inefficiency underpinning brain state dysregulation in individuals with major depressive disorder

Disruptions in brain state dynamics are a hallmark of major depressive disorder (MDD), yet their underlying mechanisms remain unclear. This study, building on network control theory, revealed that decreased state stability and increased state-switching frequency in MDD are driven by elevated energy costs and reduced control stability, indicating energy inefficiency. Key brain regions, including the left dorsolateral prefrontal cortex, exhibited impaired energy regulation capacity, and these region-specific energy patterns were correlated with depressive symptom severity. Neurotransmitter and gene expression association analyses linked these energy deficits to intrinsic biological factors, notably the 5-HT2a receptor and excitatory-inhibitory balance. These findings shed light on the energetic mechanism underlying brain state dysregulation in MDD and its associated biological underpinnings, highlighting brain energy dynamics as a potential biomarker by which to explore therapeutic targets and advance precise interventions for restoring healthy brain dynamics in depression.