Aims Electroconvulsive therapy (ECT) is an effective intervention for treatment‐resistant depression (TRD). Although prior studies have identified cerebellar functional alterations following ECT, cerebellar–cerebral functional connectivity (FC) changes remain insufficiently explored. Methods Cerebellar seeds were defined based on prior connectivity studies, targeting cerebellar regions functionally coupled with executive, default‐mode, and affective‐limbic networks. Seed‐based cerebellar–cerebral FC analyses were conducted using neuroimaging data from 72 patients with TRD (52 of whom completed post‐ECT assessment) and 63 healthy controls (HCs). Correlation analyses assessed clinical associations, and support vector regression was applied to predict treatment response using baseline FC. Neuroimaging–transcriptomic association analyses were conducted to identify gene expression patterns correlated with post‐ECT FC alterations. Results Compared to HCs, patients with TRD exhibited decreased cerebellar connectivity with the sensorimotor network (SMN) and the default‐mode network (DMN). Following ECT, TRD patients showed significant alleviation of depressive symptoms, which was accompanied by a marked increase in cerebellar–DMN connectivity. Enhanced FCs between the left Crus II Exec2 and the bilateral medial superior frontal gyrus were positively correlated with Hamilton Depression Rating Scale (HAMD) score reduction ( r = 0.343, P = 0.026). Additionally, baseline FC of the left Crus II Exec2 significantly predicted HAMD reduction ( r = 0.412, P < 0.001). Neuroimaging–transcription association analysis revealed these FC alterations were associated with normative gene patterns enriched in synaptic signaling, ion channel, and chromatin remodeling. Conclusions TRD is associated with reduced cerebellar–SMN and cerebellar–DMN connectivity. ECT may enhance cerebellar–DMN connectivity, potentially contributing to antidepressant effects.
Zhang et al. (Thu,) studied this question.