Attentional control, rumination and recurrence of depression

What is high rumination?

OBJECTIVE

The current paper tries to illuminate the need for standard cutoff points.

INTRODUCTION

rumination is considered to be a transdiagnostic process leading to a variety of consequences. But, what is prominent ruminative tendency? Are there agreed-upon specifications or cutoff points that distinguish between high and low tendency to ruminate? In an attempt to answer these questions, we reviewed 25 works that compared people characterized as high or low in rumination. We found numerous inconsistencies in the characterization criteria and a great variability in cutoff points. Most studies did not provide enough information about the cutoff criteria or values.

METHOD

We examined a sample of 454 participants using the RRS (Ruminative Response Scale), from which we tried to identify standard cutoff points.

RESULTS SHOWED

1) distributions of RRS, brooding and reflective pondering; 2) most studies used median split, which might explain the differences among studies; 3) examination of standard scores for the various cutoffs presented big variability among the studies; and 4) women had higher scores of rumination and brooding than men.

CONCLUSION

Our paper highlights the need for homogeneity in the field. It suggests addressing the RRS, brooding and reflective pondering distributions as references for future studies. We recommend specifying: cutoff criteria, cutoff values, range, means and standard deviations. Researchers should consider the specific population (i.e., men vs. women or clinical vs. non clinical) of interest and infer specific cutoff points accordingly. Importantly, researchers should consider the implications of their choice of cutoff points and apply their criterion accordingly.

Rumination, psychological capital and academic procrastination among nursing students: A cross-sectional study

BACKGROUND

Academic procrastination is common among college students, which affects their learning status and even their physical and mental health. Rumination, psychological capital, and academic procrastination are closely related, but for nursing students, there are few studies reporting on their levels and relationships.

OBJECTIVE

The aim of this study was to investigate the levels of rumination, psychological capital, and academic procrastination among nursing students, and examine the mediating role of psychological capital in rumination and academic procrastination.

DESIGN

A cross-sectional study.

SETTING

The study sampled three medical colleges in Sichuan Province, China.

PARTICIPANTS

A convenience sampling method was used to select 556 nursing students from April to June 2023.

METHODS

556 nursing students were asked to complete questionnaires regarding social-demographic information, rumination, psychological capital, and academic procrastination. Descriptive statistics, Pearson correlation analysis and structural equation model were used in this study.

RESULTS

The scores of rumination, psychological capital, and academic procrastination among nursing students were 46.08 ± 13.61, 108.28 ± 19.50 and 55.32 ± 12.30, respectively. Additionally, structural equation modeling showed that psychological capital mediated the relationship between rumination and academic procrastination with the partial mediating effect of 0.425.

CONCLUSION

Our results suggest that nursing students exhibit moderate levels of rumination, psychological capital and academic procrastination. Moreover, rumination can not only directly affect academic procrastination, but also indirectly through psychological capital. Nursing educators should strengthen their attention to the mental health and learning status of nursing students, take measures to help them adapt to campus life, alleviate rumination, enrich psychological capital, and reduce the risk of academic procrastination.

Trait anxiety predicting the developmental trajectories of depression symptoms in children: The mediating role of attentional control

Trait anxiety and attentional control are important factors related to depression symptoms. The study investigated how trait anxiety and attentional control predicted the trajectories of depression symptoms during the transition into early adolescence. The mediating effect of attentional control on the relationship of trait anxiety to the trajectories of depression symptoms was also examined. Children of 9 to 10 years were recruited at Time 1. Trait anxiety, attentional control, and depression symptoms were assessed at Time 1. Depression symptoms were measured at three follow-up assessments across 18 months. Latent class growth modeling revealed high (14.4%) and low (85.6%) trajectories of depression symptoms. Higher trait anxiety and lower attentional control predicted a higher likelihood of showing the trajectory of high depressive symptoms. Attentional control mediated the relationship of trait anxiety to the trajectory membership of depression symptoms. The findings had important implications for the association of trait anxiety with the trajectory membership of depression symptoms and highlighted the importance of attentional control in the development of depression symptoms for children with high trait anxiety.

Mindfulness-based cognitive therapy improves insomnia symptoms in individuals with recurrent depression: secondary analyses from a randomized controlled trial

Background

Embedded within a randomized efficacy trial, the present study aimed to investigate whether mindfulness-based cognitive therapy (MBCT) for recurrent depression improved symptoms of insomnia.

Methods

Sixty-eight remitted participants with at least three prior episodes of depression were randomized to 8 weeks of MBCT (n = 33) or a waitlist control condition (n = 35). The Bergen Insomnia Scale was used to screen for insomnia symptoms before and after the intervention. The analyses were conducted using one-way between-groups analyses of covariance.

Results

Twenty-five MBCT participants and 30 waitlist controls completed the study (74.5% females; mean age 40.7 ± 12.9 years). At baseline, 83.6% screened positive for the insomnia diagnosis. Following the intervention and after controlling for corresponding insomnia parameters at baseline, MBCT completers reported significantly less severe insomnia symptoms (p = 0.017), as well as less problems with prolonged sleep onset (p = 0.047) and nocturnal awakenings (p = 0.023), relative to controls. No group differences were found on early morning awakening, daytime impairment, or dissatisfaction with sleep.

Conclusion

The results suggest that MBCT improves certain insomnia symptoms. However, additional sleep-specific interventions may be needed to further improve this population's sleep.Clinical Trial Registration: ISRCTN, ISRCTN18001392, registered 22/11/2018. URL: 10.1186/ISRCTN18001392.

Rumination Induction Task in fMRI: Test-Retest Reliability in Youth and Potential Mechanisms of Change with Intervention

Background

Rumination is a transdiagnostic problem that is common in major depressive disorder (MDD). Rumination Focused Cognitive Behavioral Therapy (RF-CBT) explicitly targets the ruminative habit. This study examined changes in brain activation during a rumination induction task in adolescents with remitted MDD following RF-CBT. We also evaluated the reliability of the rumination task among adolescents who received treatment as usual (TAU).

Method

Fifty-five adolescents ages 14-17 completed a self-relevant rumination induction fMRI task and were then randomized to either RF-CBT (n = 30) or TAU (n = 25). Participants completed the task a second time either following 10-14 sessions of RF-CBT or the equivalent time delay for the TAU group. We assessed activation change in the RF-CBT group using paired-samples t-tests and reliability by calculating intraclass correlation coefficients (ICCs) of five rumination-related ROIs during each of three blocks for the TAU and RF-CBT groups separately (Rumination Instruction, Rumination Prompt, and Distraction).

Results

Following treatment, participants in the RF-CBT group demonstrated an increase in activation of the left precuneus during Rumination Instruction and the left angular and superior temporal gyri during Rumination Prompt ( p < .01). The TAU group demonstrated fair to excellent reliability ( M = .52, range = .27-.86) across most ROIs and task blocks. In contrast, the RF-CBT group demonstrated poor reliability across most ROIs and task blocks ( M = .21, range = -.19-.69).

Conclusion

RF-CBT appears to lead to rumination-related brain change. We demonstrated that the rumination induction task has fair to excellent reliability among individuals who do not receive an intervention that explicitly targets the ruminative habit, whereas reliability of this task is largely poor in the context of RF-CBT. This has meaningful implications in longitudinal and intervention studies, particularly when conceptualizing it as an important target for intervention. It also suggests one of many possible mechanisms for why fMRI test-retest reliability can be low that appears unrelated to the methodology itself.

Modulation of resting-state functional connectivity in default mode network is associated with the long-term treatment outcome in major depressive disorder

BACKGROUND

Treatment non-response and recurrence are the main sources of disease burden in major depressive disorder (MDD). However, little is known about its neurobiological mechanism concerning the brain network changes accompanying pharmacotherapy. The present study investigated the changes in the intrinsic brain networks during 6-month antidepressant treatment phase associated with the treatment response and recurrence in MDD.

METHODS

Resting-state functional magnetic resonance imaging was acquired from untreated patients with MDD and healthy controls at baseline. The patients' depressive symptoms were monitored by using the Hamilton Rating Scale for Depression (HAMD). After 6 months of antidepressant treatment, patients were re-scanned and followed up every 6 months over 2 years. Traditional statistical analysis as well as machine learning approaches were conducted to investigate the longitudinal changes in macro-scale resting-state functional network connectivity (rsFNC) strength and micro-scale resting-state functional connectivity (rsFC) associated with long-term treatment outcome in MDD.

RESULTS

Repeated measures of the general linear model demonstrated a significant difference in the default mode network (DMN) rsFNC change before and after the 6-month antidepressant treatment between remitters and non-remitters. The difference in the rsFNC change over the 6-month antidepressant treatment between recurring and stable MDD was also specific to DMN. Machine learning analysis results revealed that only the DMN rsFC change successfully distinguished non-remitters from the remitters at 6 months and recurring from stable MDD during the 2-year follow-up.

CONCLUSION

Our findings demonstrated that the intrinsic DMN connectivity could be a unique and important target for treatment and recurrence prevention in MDD.

The Emotion-Regulation Benefits of Implicit Reappraisal in Clinical Depression: Behavioral and Electrophysiological Evidence

Major depressive disorder (MDD) is characterized by emotion dysregulation. Whether implicit emotion regulation can compensate for this deficit remains unknown. In this study, we recruited 159 subjects who were healthy controls, had subclinical depression, or had MDD, and examined them under baseline, implicit, and explicit reappraisal conditions. Explicit reappraisal led to the most negative feelings and the largest parietal late positive potential (parietal LPP, an index of emotion intensity) in the MDD group compared to the other two groups; the group difference was absent under the other two conditions. MDD patients showed larger regulatory effects in the LPP during implicit than explicit reappraisal, whereas healthy controls showed a reversed pattern. Furthermore, the frontal P3, an index of voluntary cognitive control, showed larger amplitudes in explicit reappraisal compared to baseline in the healthy and subclinical groups, but not in the MDD group, while implicit reappraisal did not increase P3 across groups. These findings suggest that implicit reappraisal is beneficial for clinical depression.

Neural signal variability relates to maladaptive rumination in depression

Rumination is a common feature of depression and predicts the onset and maintenance of depressive episodes. Maladaptive and adaptive subtypes of rumination contribute to distinct outcomes, with brooding worsening negative mood and reflection related to fewer depression symptoms in healthy populations. Neuroimaging studies have implicated several cortical midline and lateral prefrontal brain regions in rumination. Recent research indicates that blood oxygen level-dependent (BOLD) signal variability may be a novel predictor of cognitive flexibility. However, no prior studies have investigated whether brooding and reflection are associated with distinct patterns of BOLD signal variability in depression. We collected resting-state fMRI data for 79 women with different depression histories: no history, past history, and current depression. We examined differences in BOLD signal variability (BOLD_SD) related to rumination subtypes for the following regions of interest previously implicated in rumination: amygdala, medial prefrontal, anterior cingulate, posterior cingulate, and dorsolateral prefrontal cortices (dlPFC). Rumination subtype was associated with BOLD_SD in the dlPFC, with greater levels of brooding associated with lower BOLD_SD in the dlPFC, even after controlling for depression severity. Depression history was related to BOLD_SD in the dlPFC, with reduced BOLD_SD in those with current depression versus no history of depression. These findings provide a novel demonstration of the neural circuitry associated with maladaptive rumination in depression and implicate decreased prefrontal neural signal variability in the pathophysiology of depression.

Associations between mothers' emotion regulation and real-time experiences of negative emotion: The moderating role of caregiving context

Parents' emotion regulation and emotional experiences have important consequences for family well-being and child outcomes. Little is known about whether traitlike emotion regulation abilities predict statelike experiences of real-time negative emotion. Using ecological momentary assessment (EMA), this study examines associations between mothers' self-reported emotion regulation abilities and their real-time experiences of negative emotion, as well as the moderating role of caregiving context among 145 mothers (41% Hispanic; 31% earned below $40,000) of young children (mean age = 20.9 months) across a 10-day period. Results indicated that on average, mothers who report high levels of traitlike rumination and difficulties in emotion regulation also report more statelike negative emotion. Further, the presence of children weakened the associations between mothers' traitlike reports of emotion dysregulation and statelike EMA negative emotion reports. The findings demonstrate the importance of parents' emotion regulation for supporting family well-being, especially when parents are separated from their children; the findings may have implications for developing family interventions.

Computerized Working Memory Training in Remission From Major Depressive Disorder: Effects on Emotional Working Memory, Processing Speed, Executive Functions, and Associations With Symptoms

Introduction

Remission from major depressive disorder (MDD) is associated with residual symptoms related to reduced functioning, quality of life, and relapse risk. Previous studies have raised questions about mechanisms involved-in and affected by cognitive training. This study investigated the associations and changes among depressive symptoms, rumination, processing speed (PS), executive functioning (EF), and emotional working memory (e-WM) pre- post computerized working memory training (CWMT).

Method

Twenty-nine remitted participants were included in a pre- post pilot study of within-subject effects of online CWMT. A total of 20 participants completed the intervention and pre- post tests of EF and PS, e-WM, in addition to symptom and rumination measures. Associations between changes in symptoms and cognition were investigated pre- post. Associations between improvements in CWMT, depression history, and changes in cognition were explored. Hypotheses and statistics were preregistered before data were analyzed.

Results

Manipulation of negatively valanced stimuli in e-WM showed an inverse association with rumination pre-intervention, but the association disappeared post-intervention. Cognitive functioning improved in most conditions with largest effects in EF. Symptoms did not change in the remitted sample. CWMT improvements were related to improvements in some aspects of EF and PS, but also to worse self-reported attention. Depression history was related to less improvement in EF.

Limitations

Sample size was small and there was dropout from the study. There was no control group, thus precluding practice and placebo effects and causal relationships.

Conclusions

Computerized WM training improves cognitive functions and could influence associations between e-WM and rumination. This could counteract functional impairment following MDD.

Neural basis of positive and negative emotion regulation in remitted depression

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RRMDD patients show deviant uninstructed neural emotion regulation.

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This is reflected in residual problems in daily strategy use.

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RRMDD patients are capable to engage frontolimbic areas upon instructed reappraisal.

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Neural regulation capacity is related to inadequate rumination.

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Positive, next to negative, affect is highly relevant for understanding vulnerability.

The recurrent nature of Major Depressive Disorder (MDD) necessitates a better understanding of mechanisms facilitating relapse. MDD has often been associated with abnormal emotion regulation, underpinned by aberrant interactions between the prefrontal cortex and subcortical areas. We assessed whether neural regulation abnormalities remain after remission and relate to emotion regulation problems in daily life.

At the baseline measurement of a randomized controlled trial, an emotion regulation task was performed during fMRI scanning by 46 remitted recurrent (rrMDD) patients and 24 healthy controls. We assessed both fMRI peak activity and the temporal dynamics of the neural response during passive attendance and explicit regulation of positive and negative emotions. Furthermore, we assessed regulation strategy use in daily life using questionnaires, and attentional biases using a modified attentional dot-probe task.

RrMDD patients showed lower activation and different temporal dynamics in occipital, parietal, and prefrontal brain regions during passive attendance of emotional material compared to healthy controls. During explicit downregulation of negative emotions, no group differences were found. However, during explicit upregulation of positive emotions, rrMDD patients showed a different neural response over time in the insula. Behaviourally, rrMDD patients were characterized by dysfunctional regulation strategies in daily life. Within rrMDD patients, rumination was associated with activation within a limbic- prefrontal network.

After remission, immediate emotional processing seems unaffected, but regulatory abnormalities remain, especially uninstructed and in daily life. Abnormal insula activation during positive upregulation suggests decreased monitoring of positive emotions. The relation between inadequate rumination and brain activity during emotion regulation suggests that regulation of both positive and negative affect is important in understanding neurocognitive underpinnings of resilience.

Potential structural trait markers of depression in the form of alterations in the structures of subcortical nuclei and structural covariance network properties

It has been proposed recently that major depressive disorder (MDD) could represent an adaptation to conserve energy after the perceived loss of an investment in a vital source, such as group identity, personal assets, or relationships. Energy conserving behaviors associated with MDD may form a persistent marker in brain regions and networks involved in cognition and emotion regulation. In this study, we examined whether subcortical regions and volume-based structural covariance networks (SCNs) have state-independent alterations (trait markers). First-episode drug-naïve currently depressed (cMDD) patients (N = 131), remitted MDD (RD) patients (N = 67), and healthy controls (HCs, N = 235) underwent structural magnetic resonance imaging (MRI). Subcortical gray matter volumes (GMVs) were calculated in FreeSurfer software, and group differences in GMVs and SCN were analyzed. Compared to HCs, major findings were decreased GMVs of left pallidum and pulvinar anterior of thalamus in the cMDD and RD groups, indicative of a trait marker. Relative to HCs, subcortical SCNs of both cMDD and RD patients were found to have reduced small-world-ness and path length, which together may represent a trait-like topological feature of depression. In sum, the left pallidum, left pulvinar anterior of thalamus volumetric alterations may represent trait marker and reduced small-world-ness, path length may represent trait-like topological feature of MDD.

The pathways from perceived discrimination to self-rated health among the Chinese diaspora during the COVID-19 pandemic: investigation of the roles of depression, anxiety, and social support

BACKGROUND

Research indicates the adverse impacts of perceived discrimination on health, and discrimination inflamed by the COVID-19 pandemic, a type of social exclusion, could affect the well-being of the Chinese diaspora. We analyzed the relationship and pathways of perceived discrimination's effect on health among the Chinese diaspora in the context of the pandemic to contribute to the literature on discrimination in this population under the global public health crisis.

METHODS

We analyzed data from 705 individuals of Chinese descent residing in countries outside of China who participated in a cross-sectional online survey between April 22 and May 9, 2020. This study utilized a structural equation model (SEM) to evaluate both direct and indirect effects of perceived discrimination on self-rated health (SRH) and to assess the mediating roles of psychological distress (namely, anxiety and depression) and social support from family and friends.

RESULTS

This online sample comprised predominantly young adults and those of relatively high socioeconomic status. This study confirmed the total and direct effect of recently perceived discrimination on SRH and found the indirect effect was mainly mediated by depression. Mediating roles of anxiety and social support on the discrimination-health relationship were found insignificant in this SEM.

CONCLUSIONS

Our findings suggest discrimination negatively affected the well-being of the Chinese diaspora, and depression acted as a major mediator between the discrimination-health relationship. Therefore, interventions for reducing discrimination to preserve the well-being of the Chinese diaspora are necessary. Prompt intervention to address depression may partially relieve the disease burden caused by the surge of discrimination.

Identifying the subtypes of psychological profiles in senior undergraduate nursing students and its relationship with academic performance: A latent class analysis

BACKGROUND

Students' academic performance is closely related to their personal psychological factors. The subtypes and heterogeneity of psychological profiles among nursing students has not been systematically examined.

PURPOSE

To identify subtypes of psychological profiles among nursing students using latent class analysis (LCA).

METHODS

A cross-sectional study design included 379 senior nursing undergraduate students aged 18-22 from three medical colleges in Shanghai. The subjects were investigated by Ruminative Responses Scale, Academic Burnout Scale and Psychological Capital Scale and were categorized into subtypes by LCA.

RESULTS

Four latent classes were identified: Class 1 - General group; Class 2 - Negative psychological dominated group; Class 3 - Positive psychological dominated group; and Class 4 - Ambivalence psychological group. Students with higher exam failure rate were more likely to belong to Class 2. After adjusted for demographic variables, the subtypes of psychological profiles significantly correlated with academic performance.

CONCLUSIONS

The significant heterogeneities were noted between psychological profile subtypes and academic performance among senior undergraduate nursing students.

The Habenula in the Link Between ADHD and Mood Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset, neurodevelopmental disorder, whereas major depressive disorder (MDD) is a mood disorder that typically emerges in adulthood. Accumulating evidence suggests that these seemingly unrelated psychiatric disorders, whose symptoms even appear antithetical [e.g., psychomotor retardation in depression vs. hyperactivity (psychomotor acceleration) in ADHD], are in fact associated with each other. Thus, individuals with ADHD exhibit high comorbidity with MDD later in life. Moreover, genetic studies have shown substantial overlaps of susceptibility genes between ADHD and MDD. Here, we propose a novel and testable hypothesis that the habenula, the epithalamic brain region important for the regulation of monoamine transmission, may be involved in both ADHD and MDD. The hypothesis suggests that an initially hypoactive habenula during childhood in individuals with ADHD may undergo compensatory changes during development, priming the habenula to be hyperactive in response to stress exposure and thereby increasing vulnerability to MDD in adulthood. Moreover, we propose a new perspective on habenular deficits in psychiatric disorders that consider the habenula a neural substrate that could explain multiple psychiatric disorders.

A Brief Online Mindfulness-Based Group Intervention for Psychological Distress Among Chinese Residents During COVID-19: a Pilot Randomized Controlled Trial

Objectives

The coronavirus (COVID-19) global pandemic has increased psychological distress among the general population. The objective of this study is to evaluate a mindfulness-based intervention for psychological distress among Chinese residents during COVID-19.

Methods

This study used a switching replications design to test the feasibility and efficacy of a brief online mindfulness-based intervention for Chinese residents’ psychological distress. Fifty-one residents in the Hubei province were randomly allocated to two groups (experimental group and waitlist control group) with three waves of measurement at time 1, time 2, and time 3 for changes in mindfulness and psychological distress.

Results

In addition to significant within-group improvements over time for both groups, OLS linear regression with full information likelihood estimation revealed statistically significant between-group treatment effects across outcome domains, including mindfulness awareness, b = 2.84, p < 0.001, g = 6.92, psychological distress, b = −21.33, p < 0.001, g = 6.62, somatic symptoms, b = −6.22, p < 0.001, g = 4.42, depressive symptoms, b = −7.16, p < 0.001, g = 5.07, and anxiety symptoms, b = −8.09, p < 0.001, g = 6.84.

Conclusions

Results suggest that a brief online mindfulness-based intervention can be a feasible and promising intervention for improving mindfulness and decreasing psychological distress among Chinese residents staying at home during the COVID-19 outbreak. The study used a small convenience sample which led to a concern of external generalizability and with limited evaluation of long-term change.

Temporal and Reciprocal Relations Between Worry and Rumination Among Subgroups of Metacognitive Beliefs

Metacognitive theory provides strong foundation for hypothesizing relations between worry and rumination among subgroups of metacognitive beliefs. However, empirical exploration of prospective and reciprocal relations between worry and rumination are lacking. This study investigated the stability and relations between worry and rumination to better understand how they influence each other over time, and how different levels of metacognitive beliefs affect relations between (i) initial and future worry, and initial and future rumination, and (ii) the cross-lag relations between worry and rumination. Overall, 482 (Females = 63%) participants (Mean age = 26 years) participated in a two-wave data collection and completed the Metacognition Questionnaire (MCQ-30), the Ruminative Response Scale and the Penn State Worry Questionnaire (PSWQ). A multigroup two-wave autoregressive cross-lagged model was estimated. Multigroup autoregression analyses revealed that independent of participants being in the high or low metacognition group, initial levels of worry predicted future levels of worry, as was the case for rumination. Multigroup cross-lagged analyses revealed that initial levels of worry did not predict future levels of rumination in both high and low levels of metacognitions. However, initial rumination predicted future levels of worry in the high metacognitions group, which was not the case for the low metacognitions group. Thus, high levels of metacognitions do not only strengthen the relation between both present and future worry, present and future rumination, but also present rumination with future worry. This finding may imply that those with rumination related conditions at present are more likely in the future to show both rumination and worry related conditions. Conversely, those with worry related conditions show future worry related conditions. These findings may have implications for a clinical sample regarding the high complexity of rumination conditions that may proceed with multifinality causal pathways especially for individuals with high levels of metacognitions. This complexity may be a possible explanation for the limited success in other traditional treatment of rumination related conditions and the relatively high relapse rates for such conditions in clinical samples.

Improved and residual functional abnormalities in major depressive disorder after electroconvulsive therapy

Electroconvulsive therapy (ECT) can induce fast remission of depression but still retain the residual functional impairments in major depressive disorder (MDD) patients. To delineate the different functional circuits of effective antidepressant treatment and residual functional impairments is able to better guide clinical therapy for depression. Herein, voxel-level whole brain functional connectivity homogeneity (FcHo), functional connectivity, multivariate pattern classification approaches were applied to reveal the specific circuits for treatment response and residual impairments in MDD patients after ECT. Increased FcHo values in right dorsomedial prefrontal cortex (dmPFC) and left angular gyrus (AG) and their corresponding functional connectivities between dmPFC and right AG, dorsolateral prefrontal cortex (dlPFC), superior frontal gyrus, precuneus (Pcu) and between left AG with dlPFC, bilateral AG, and left ventrolateral prefrontal cortex in MDD patients after ECT. Moreover, we found decreased FcHo values in left middle occipital gyrus (MOG) and lingual gyrus (LG) and decreased functional connectivities between MOG and dorsal postcentral gyrus (PCG) and between LG and middle PCG/anterior superior parietal lobule in MDD patients before and after ECT compared to healthy controls (HCs). The increased or normalized FcHo and functional connections may be related to effective antidepressant therapy, and the decreased FcHo and functional connectivities may account for the residual functional impairments in MDD patients after ECT. The different change patterns in MDD after ECT indicated a specific brain circuit supporting fast remission of depression, which was supported by the following multivariate pattern classification analyses. Finally, we found that the changed FcHo in dmPFC was correlated with changed depression scores. These results revealed a specific functional circuit supporting antidepressant effects of ECT and neuroanatomical basis for residual functional impairments. Our findings also highlighted the key role of dmPFC in antidepressant and will provide an important reference for depression treatment.