Amygdala–Ventral Striatum Functional Connectivity Underlies Craving in Gambling Disorder: A Mediating Role of Depressive Symptoms

Craving is an intense, strong urge to engage in addictive behaviours. Craving is supposed to be modulated by the connectivity between the amygdala and the ventral striatum (VS), a pivotal pathway for reward-seeking behaviours. However, whether and how this connectivity underlies craving for gambling remains unclear, limiting our understanding of the pathophysiology of gambling disorder (GD). To address this issue, we analysed resting-state functional connectivity (rs-FC) between the amygdala and VS in 51 GD patients and 45 healthy participants. Craving for gambling was assessed using the Gambling Craving Scale (GACS). Among three GACS subscales, Desire exhibited a significant correlation with rs-FC in the right amygdala–VS, while Anticipation and Relief showed no significant associations. Causal mediation analysis revealed that depressive symptoms significantly mediated the relationship between rs-FC in the right amygdala–VS and Desire. These findings suggest that the amygdala–VS connectivity elicits the intense desire for gambling through negative emotions.