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. 2025 Jun;275(4):1087-1097.
doi: 10.1007/s00406-024-01765-4. Epub 2024 Apr 1.

Sex differences in anhedonia in bipolar depression: a resting-state fMRI study

Xiaoqin Wang #  1 , Yi Xia #  1 , Rui Yan  1 , Hao Sun  1   2 , Yinghong Huang  1   2 , Qiudong Xia  1 , Junling Sheng  1 , Wei You  1 , Lingling Hua  1 , Hao Tang  1 , Zhijian Yao  3   4   5 , Qing Lu  6   7
Affiliations

Sex differences in anhedonia in bipolar depression: a resting-state fMRI study

Xiaoqin Wang et al. Eur Arch Psychiatry Clin Neurosci. 2025 Jun.

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: Anhedonia; Bipolar depression; Functional neuroimaging; Hippocampus; Insula; Sex difference.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that no competing interests exist. All authors disclosed no relevant relationships.

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