Pupil size-resting state network coupling in major depressive disorder: a longitudinal iTBS study

In patients with major depressive disorder undergoing iTBS, left executive control network (lECN) shows a sustained reduction in positive pupil size coupling relative to baseline, regardless of active-sham order.

• Why it matters: Altered autonomic brain communication is implicated in MDD, but how spontaneous pupillary fluctuations relate to resting-state functional networks during treatment remains unclear.
• What they did: Resting-state fMRI with concurrent pupillometry was collected at four visits; group independent component analysis estimated tonic pupil coupling to predefined RSNs, and linear mixed-effects models tested longitudinal change and moderators.
• The result: Pupil diameter decreased significantly from baseline, and larger decreases were positively associated with greater reductions in anxiety scores, which were also positively correlated with reductions in depressive symptoms.

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