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      Data-Driven Subgroups in Depression Derived from Directed Functional Connectivity Paths at Rest

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          Abstract

          Depressed patients show abnormalities in brain connectivity at rest, including hyperconnectivity within the default mode network (DMN). However, there is well-known heterogeneity in the clinical presentation of depression that is overlooked when averaging connectivity data. We used data-driven parsing of neural connectivity to reveal subgroups among 80 depressed patients completing resting state fMRI. Directed functional connectivity paths (eg, region A influences region B) within a depression-relevant network were characterized using Group Iterative Multiple Model Estimation, a method shown to accurately recover the direction and presence of connectivity paths in individual participants. Individuals were clustered using community detection on neural connectivity estimates. Subgroups were compared on network features and on clinical and biological/demographic characteristics that influence depression prognosis. Two subgroups emerged. Subgroup A, containing 71% of the patients, showed a typical pattern of connectivity across DMN nodes, as previously reported in depressed patients on average. Subgroup B exhibited an atypical connectivity profile lacking DMN connectivity, with increased dorsal anterior cingulate-driven connectivity paths. Subgroup B members had an over-representation of females (87% of Subgroup B vs 65% of Subgroup A; χ 2=3.89, p=0.049), comorbid anxiety diagnoses (42.9% of Subgroup B vs 17.5% of Subgroup A; χ 2=5.34, p=.02), and highly recurrent depression (63.2% of Subgroup B vs 31.8% of Subgroup A; χ 2=5.38, p=.02). Neural connectivity-based categorization revealed an atypical pattern of connectivity in a depressed patient subset that would be overlooked in group comparisons of depressed and healthy participants, and tracks with clinically relevant phenotypes including anxious depression and episodic recurrence. Data-driven parsing suggests heterogeneous substrates of depression; ideally, future work building on these findings will inform personalized treatment.

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          Author and article information

          Journal
          Neuropsychopharmacology
          Neuropsychopharmacology
          Neuropsychopharmacology
          Nature Publishing Group
          0893-133X
          1740-634X
          December 2017
          12 May 2017
          21 June 2017
          : 42
          : 13
          : 2623-2632
          Affiliations
          [1 ] Department of Psychiatry, University of Pittsburgh , Pittsburgh, PA, USA
          [2 ] University of North Carolina–Chapel Hill , Chapel Hill, NC, USA
          [3 ] Department of Psychology, University of Pittsburgh , Pittsburgh, PA, USA
          [4 ] Perelman School of Medicine of the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center
          Author notes
          [* ] Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh , 3811 O’Hara Street, Pittsburgh, PA 15213, USA, Tel: +1 412 383 5443, Fax: +1 412 383 4077, E-mail: rebecca.price@ 123456stanfordalumni.org
          Article
          PMC5686504 PMC5686504 5686504 npp201797
          10.1038/npp.2017.97
          5686504
          28497802
          74c18910-ea4e-4d3a-b249-5977a0ebb973
          Copyright © 2017 American College of Neuropsychopharmacology
          History
          : 09 January 2017
          : 07 April 2017
          : 05 May 2017
          Categories
          Original Article

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