Fractional amplitude of low-frequency fluctuation (fALFF) alterations in young depressed patients with suicide attempts after cognitive behavioral therapy and antidepressant medication cotherapy: A resting-state fMRI study

Background: Fractional amplitude of low-frequency fluctuation (fALFF) alterations in young depressed patients with suicide attempts after cognitive behavioral therapy (CBT) and antidepressant medication cotherapy were evaluated. Methods: Seventy-eight subjects (age: 18-28) were recruited from April 2017 to March 2019. Forty young depressed patients who attempted suicide were divided into CBT (8 weeks of structured CBT sessions and antidepressant medication cotherapy) and monotherapy (MG: antidepressant therapy alone) groups, and 38 healthy volunteers constituted a healthy control (HC) group. Resting-state functional magnetic resonance imaging (rsfMRI) was conducted before and after treatment. Results: Before treatment, spontaneous brain activity in the left posterior cerebellar lobe (L-PCL), right anterior cingulate cortex, left caudate nucleus and left superior frontal cortex was higher in untreated patients than in HCs. After treatment, fALFF in the left middle occipital cortex and left precuneus was significantly increased in the CBT compared with the HC group. fALFF in the right middle frontal cortex, right inferior frontal cortex, LPCL, and left anterior cerebellar lobe (L-ACL) were increased, while fALFF in the L-mPFC and L-SgACC were reduced, in the CBT compared with the MG group. Pearson correlation analyses provided information about clinical scale scores and mean fALFF relationships. Limitations: There was insufficient evidence to confirm that these spontaneous brain activity alterations were the result of CBT or spontaneous recovery. Conclusion: CBT and medication cotherapy can significantly change spontaneous activity in the left cerebellum and default-mode network, thereby regulating and reshaping emotional and cognitive processing.