Personalized functional topography–based multisite brain age prediction modeling reveals divergent neurodevelopment in major depression

C Chenxuan Pang (State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University) X Xiaoyi Sun (State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University) J Jianlong Zhao (State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University) X Xinyuan Liang (State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University) L Lianglong Sun (State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University) Q Qixiang Lin (State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University) J Jinrong Sun (Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University) X Xiaowen Lu (Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University) Q Qiangli Dong (Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University) L Liang Zhang X Xiaoqin Wang D Dongtao Wei (Key Laboratory of Cognition and Personality (Southwest University), Ministry of Education) Y Yuan Chen (School of Chemical and Biomolecular Engineering) B Bangshan Liu (Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University) C Chu-Chung Huang (Key Laboratory of Brain Functional Genomics (Ministry of Education), Affiliated Mental Health Center (East China Normal University), School of Psychology and Cognitive Science, East China Normal University) Y Yanting Zheng (Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine) Y Yankun Wu (Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University) T Taolin Chen (Department of Radiology, Huaxi MR Research Center, Institute of Radiology and Medical Imaging, West China Hospital of Sichuan University) Y Yuqi Cheng (Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine) Y Yong He (Department of Pathogen Biology, School of Basic Medical Sciences, Anhui Medical University) L Lingjiang Li (Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University) J Jingliang Cheng (Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University) Q Qiyong Gong (Department of Radiology, Huaxi MR Research Center, Institute of Radiology and Medical Imaging, West China Hospital of Sichuan University) C Ching-Po Lin (Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University) J Jiang Qiu (Department of Psychology, Zhejiang Normal University) S Shijun Qiu (Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine) T Tianmei Si (Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University) Y Yanqing Tang (Department of Psychiatry, The First Affiliated Hospital of China Medical University) F Fei Wang P Peng Xie (Chongqing Key Laboratory of Neurobiology) X Xiufeng Xu (Department of Medicine, Huddinge, Karolinska Institutet) M Mingrui Xia (State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University)

Abstract

Major depressive disorder (MDD) is associated with widespread alterations in functional brain networks across the lifespan. However, heterogeneity in atypical brain development among patients with MDD remains largely uncharacterized. Using a multisite resting-state functional MRI dataset consisting of 1,105 MDD patients and 1,065 healthy controls, we constructed a harmonized multicenter brain age prediction model based on individualized functional topography and identified two patient subgroups with positive or negative brain age gaps (BAGs). In patients with a positive BAG (BAG+), expansion of the salience network (SAL) into the dorsolateral prefrontal and ventrolateral prefrontal cortices, in addition to contraction of the sensorimotor and dorsal attention networks (DAN), contributes to accelerated brain aging. Conversely, in the negative BAG (BAG−) group, SAL expansion into the orbitofrontal cortex (OFC) and contraction of the visual and sensorimotor networks (SMN) were linked to delayed brain development. These subgroups also exhibited distinct neurodevelopmental trajectories. Clinically, BAG+ patients showed stronger associations between higher-order network topography and mood symptoms, whereas BAG− patients exhibited links between visual/default mode network topography and insomnia. At the molecular level, both groups showed enrichment of genes related to synaptic signaling but displayed distinct expression patterns and divergent expression trajectories in key neurodevelopmental gene sets. Notably, antidepressant treatment modulated the brain in ways that were specific to each subgroup. These findings reveal heterogeneous neurodevelopmental profiles in MDD with distinct biological and clinical signatures, offering insights into personalized precision medicine for this disorder.

Article Details

Volume / Issue Vol. 123, Issue 11
Published March 17, 2026
ISSN 0027-8424
Publisher National Academy of Sciences

Authors (32)

C

Chenxuan Pang

State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University

X

Xiaoyi Sun

State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University

J

Jianlong Zhao

State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University

X

Xinyuan Liang

State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University

L

Lianglong Sun

State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University

Q

Qixiang Lin

State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University

J

Jinrong Sun

Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University

X

Xiaowen Lu

Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University

Q

Qiangli Dong

Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University

L

Liang Zhang

X

Xiaoqin Wang

D

Dongtao Wei

Key Laboratory of Cognition and Personality (Southwest University), Ministry of Education

Y

Yuan Chen

School of Chemical and Biomolecular Engineering

B

Bangshan Liu

Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University

C

Chu-Chung Huang

Key Laboratory of Brain Functional Genomics (Ministry of Education), Affiliated Mental Health Center (East China Normal University), School of Psychology and Cognitive Science, East China Normal University

Y

Yanting Zheng

Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine

Y

Yankun Wu

Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University

T

Taolin Chen

Department of Radiology, Huaxi MR Research Center, Institute of Radiology and Medical Imaging, West China Hospital of Sichuan University

Y

Yuqi Cheng

Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine

Y

Yong He

Department of Pathogen Biology, School of Basic Medical Sciences, Anhui Medical University

L

Lingjiang Li

Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University

J

Jingliang Cheng

Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University

Q

Qiyong Gong

Department of Radiology, Huaxi MR Research Center, Institute of Radiology and Medical Imaging, West China Hospital of Sichuan University

C

Ching-Po Lin

Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University

J

Jiang Qiu

Department of Psychology, Zhejiang Normal University

S

Shijun Qiu

Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine

T

Tianmei Si

Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University

Y

Yanqing Tang

Department of Psychiatry, The First Affiliated Hospital of China Medical University

F

Fei Wang

P

Peng Xie

Chongqing Key Laboratory of Neurobiology

X

Xiufeng Xu

Department of Medicine, Huddinge, Karolinska Institutet

M

Mingrui Xia

State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University