Brain Structural Correlates of an Impending Initial Major Depressive Episode

Abstract

BackgroundNeuroimaging research has yet to elucidate, whether reported gray matter volume (GMV) alterations in major depressive disorder (MDD) exist already before the onset of the first episode. Recruitment of presently healthy individuals with a known future transition to MDD (converters) is extremely challenging but crucial to gain insights into neurobiological vulnerability. Hence, we compared converters to patients with MDD and sustained healthy controls (HC) to distinguish pre-existing neurobiological markers from those emerging later in the course of depression. MethodsCombining two clinical cohorts (n=1709), voxel-wise GMV of n=45 converters, n=748 patients with MDD, and n=916 HC were analyzed in regions-of-interest approaches. By contrasting the subgroups and considering both remission state and reported recurrence at a 2-year clinical follow-up, we stepwise disentangled effects of 1) vulnerability, 2) the acute depressive state, and 3) an initial vs. a recurrent episode. ResultsAnalyses revealed higher amygdala GMV in converters relative to HC (pTFCE-FWE=.037, d=0.447) and patients (pTFCE-FWE=.005, d=0.508), remaining significant when compared to remitted patients with imminent recurrence. Lower GMV in the dorsolateral prefrontal cortex (pTFCE-FWE<.001, d=0.188) and insula (pTFCE-FWE=.010, d=0.186) emerged in patients relative to HC but not to converters, driven by patients with acute MDD. ConclusionBy examining one of the largest available converter samples in psychiatric neuroimaging, this study allowed a first determination of neural markers for an impending initial depressive episode. Our findings suggest a temporary vulnerability, which in combination with other common risk factors might facilitate prediction and in turn improve prevention of depression.