Functional Connectivity of the Precuneus in Unmedicated Patients With Depression.

Background: The precuneus has connectivity with brain systems implicated in depression.

Methods: We performed the first fully voxel-level resting-state functional connectivity (FC) neuroimaging analysis of depression of the precuneus, with 282 patients with major depressive disorder and 254 control subjects.

Results: In 125 unmedicated patients, voxels in the precuneus had significantly increased FC with the lateral orbitofrontal cortex, a region implicated in nonreward that is thereby implicated in depression. FC was also increased in depression between the precuneus and the dorsolateral prefrontal cortex, temporal cortex, and angular and supramarginal areas. In patients receiving medication, the FC between the lateral orbitofrontal cortex and precuneus was decreased back toward that in the control subjects. In the 254 control subjects, parcellation revealed superior anterior, superior posterior, and inferior subdivisions, with the inferior subdivision having high connectivity with the posterior cingulate cortex, parahippocampal gyrus, angular gyrus, and prefrontal cortex. It was the ventral subdivision of the precuneus that had increased connectivity in depression with the lateral orbitofrontal cortex and adjoining inferior frontal gyrus.

Conclusions: The findings support the theory that the system in the lateral orbitofrontal cortex implicated in the response to nonreceipt of expected rewards has increased effects on areas in which the self is represented, such as the precuneus. This may result in low self-esteem in depression. The increased connectivity of the precuneus with the prefrontal cortex short-term memory system may contribute to the rumination about low self-esteem in depression. These findings provide evidence that a target to ameliorate depression is the lateral orbitofrontal cortex.