Xiaoqin Wang1 · Yi Xia1 · Rui Yan1 · Hao Sun1,2 · Yinghong Huang1,2 · Qiudong Xia1 · Junling Sheng1 · Wei You1 ·
Lingling Hua1 · Hao Tang1 · Zhijian Yao1,2,3 · Qing Lu3,4

Received: 7 June 2023 / Accepted: 13 January 2024
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2024

Abstract
Previous studies about anhedonia symptoms in bipolar depression (BD) ignored the unique role of gender on brain function. This study aims to explore the regional brain neuroimaging features of BD with anhedonia and the sex differences in these patients. The resting-fMRI by applying fractional amplitude of low-frequency fluctuation (fALFF) method was estimated in 263 patients with BD (174 high anhedonia [HA], 89 low anhedonia [LA]) and 213 healthy controls. The effects of two different factors in patients with BD were analyzed using a 3 (group: HA, LA, HC) × 2 (sex: male, female) ANOVA. The fALFF values were higher in the HA group than in the LA group in the right medial cingulate gyrus and supplementary motor area. For the sex-by-group interaction, the fALFF values of the right hippocampus, left medial occipital gyrus, right insula, and bilateral medial cingulate gyrus were significantly higher in HA males than in LA males but not females. These results suggested that the pattern of high activation could be a marker of anhedonia symptoms in BD males, and the sex differences should be considered in future studies of BD with anhedonia symptoms.

Keywords Bipolar depression · Anhedonia · Sex difference · Functional neuroimaging · Hippocampus · Insula

GKB-NON-2024-00204