Relationship between illness duration, corpus callosum changes, and sustained attention dysfunction in major depressive disorder

Background: Illness duration is the main index of cumulative illness severity during depression progression. Corpus callosum (CC) damage is among the most replicated neurobiological findings in major depressive disorder (MDD). We aimed to investigate the nature and extent of the association between illness duration and CC changes. Methods: Ninety-six MDD patients and 50 controls underwent diffusion and resting-state functional magnetic resonance imaging (fMRI). White matter micro-structure and inter-hemispheric functional connectivity were quantified by fractional anisotropy (FA) and voxel-mirrored homotopic connectivity (VMHC). The CC was reconstructed by tractography and divided into five sub-regions. The associations of illness duration with FA of each CC sub-region and voxel-wise VMHC were examined using correlation analyses. Also, we investigated the potential relationship between illness duration, CC changes, and clinical variables using mediation analyses. Results: In MDD patients, longer illness duration was selectively associated with lower FA of CC sub-regions 2 [partial correlation coefficient (pr) =-0.269, P=0.009] and 5 (pr=-0.296, P=0.004) as well as higher VMHC in the supplementary motor areas (pr=0.378, P<0.001), precuneus (pr=0.384, P<0.001), and lingual gyrus (pr=0.373, P<0.001) connected by the affected CC sub-regions. Further subgroup analyses demonstrated pronounced FA decrease and VMHC increase in patients with illness duration over 20 years relative to healthy controls (HC) and other patient subgroups with shorter illness durations. Moreover, lower FA of CC sub-regions 2 and 5 mediated the association between longer illness duration and more severe sustained attention dysfunction. Conclusions: These findings provide evidence for compromised structure yet compensatory function of the CC with increasing depression illness duration, which may inform effective antidepressant treatment strategies at different disease stages.