Functional connectivity between subgenual anterior cingulate cortex and dorsomedial prefrontal cortex predicts clinical symptom improvement following total sleep deprivation in treatment resistant depression

Patients with treatment-resistant depression (TRD) can experience transient improvement in depressive symptoms after total sleep deprivation (TSD). TRD patients commonly present structural and functional alterations of subgenual anterior cingulate cortex (sgACC) and dorsomedial prefrontal cortex (dmPFC). However, at the functional level, the neuronal mechanisms underlying the depressive symptom improvement following TSD in TRD patients remains unclear. The current study included thirty-eight TRD patients and thirty-four healthy controls. We aimed to investigate whether resting-state functional connectivity (FC) between sgACC and dmPFC showed differences associated with the treatment effect following one night of TSD in TRD patients. Concerning the clinical improvement, in line with previous literature, we found that the TSD treatment reduced the Hamilton Depression Rating Scale (HDRS) score, the Stress score, the Behavioral Inhibition System score, and the Behavioral Activation System-Reward score. At the FC level, we reported that, in TRD patients, the sgACC-dmPFC FC at baseline was lower compared to the one of healthy controls, and that it significantly increased following one night of TSD. Furthermore, the sgACC-dmPFC FC at baseline in TRD patients was positively correlated with changes of HDRS score. These results suggests that the depressive symptom improvement following TSD in TRD patients might be involved in the resting-state sgACC-dmPFC FC.