Glutamatergic and Redox Abnormalities in Major Depressive Disorder: Links to Childhood Maltreatment and Perceived Stress

Background: Childhood sexual abuse (CSA) increases the risk for major depressive disorder (MDD), yet the underlying neurobiological mechanisms remain poorly understood. We examined (1) associations of medial prefrontal cortex (mPFC) glutamatergic metabolites and redox balance with childhood maltreatment and MDD; and (2) whether these neurochemical measures predicted future perceived stress. Methods: Using proton and phosphorus 4T magnetic resonance spectroscopy, we quantified glutamate, glutamine, their sum (Glx), and the NAD/NADH ratio within the same mPFC voxel in 71 women across four groups: healthy controls (HC; n=27), current MDD without CSA (n=14), current MDD with CSA (n=14), and remitted MDD with CSA (n=16). Results: Glutamate and Glx levels were lower in both CSA-exposed groups (n=30) compared with HC (n=27), whereas women with MDD without CSA did not differ significantly from HC. Among CSA-exposed women, greater maltreatment severity was associated with lower glutamine, and greater maltreatment multiplicity with lower glutamate and Glx, specifically in women with current MDD. The association between depressive symptom severity and glutamine differed by CSA history. A significant interaction between baseline NAD/NADH ratio and clinical group predicted perceived stress at 6-month follow-up, adjusting for baseline perceived stress. Specifically, lower baseline NAD/NADH ratio predicted greater subsequent perceived stress in MDD without CSA, but not in the other clinical groups. Conclusions: Our findings suggest that mPFC glutamatergic metabolites and redox balance show distinct patterns of association with CSA history, depression status, and subsequent perceived stress, highlighting neurochemical heterogeneity in MDD and molecular markers of risk.