Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY, United States.
Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States; New York University School of Medicine, New York, NY, United States.
J Affect Disord. 2021 Jan 1;278:433-442. doi: 10.1016/j.jad.2020.09.074. Epub 2020 Sep 18.
Adolescent depression varies considerably in its course. However, there remain no biobehavioral predictors of illness trajectory, and follow-up studies in depressed youth are sparse. Here, we sought to examine whether reward function would predict future clinical outcomes in adolescents with depressive symptoms. We utilized the reward flanker fMRI task to assess brain function during distinct reward processes of anticipation, attainment, and positive prediction error (PPE, i.e. receiving uncertain rewards).
Subjects were 29 psychotropic-medication-free adolescents with mood and anxiety symptoms and 14 healthy controls (HC). All had psychiatric evaluations at baseline and approximately 24-month follow-up. Thirty-two participants (10 HC) had usable fMRI data. Correlation and hierarchical regression models examined baseline symptom severity measures as predictors of follow-up clinical outcomes. Whole-brain analyses examined relationships between neural reward processes and follow-up outcomes.
Clinically, anhedonia, but not irritability, predicted future depression and suicidal ideation. Among reward processes, only baseline neural activation during PPE correlated with follow-up depression and anhedonia severity. Specifically, activation in the left angular gyrus-a component of the default mode network-was associated with future depression, while activation in the dorsal anterior cingulate, operculum, and left insula-key salience and pain network regions-was associated with future anhedonia, even when controlling for baseline anhedonia.
The small sample size and variable follow-up intervals limit the generalizability of conclusions.
This research suggests that reward dysfunction, indexed by anhedonia, may predict worse clinical trajectories in depressed youth. Adolescents presenting with significant anhedonia should be carefully monitored for illness progression.
青少年抑郁症的病程差异很大。然而，目前仍然没有生物学行为预测疾病轨迹的指标，而且对抑郁青少年的随访研究也很少。在这里，我们试图研究奖励功能是否可以预测有抑郁症状的青少年的未来临床结局。我们利用奖励侧翼 fMRI 任务来评估在不同的奖励过程中，即预期、获得和积极预测误差（即接受不确定的奖励）期间的大脑功能。
研究对象为 29 名无精神药物治疗的有情绪和焦虑症状的青少年和 14 名健康对照组（HC）。所有受试者在基线和大约 24 个月的随访时都进行了精神病学评估。32 名参与者（10 名 HC）有可用的 fMRI 数据。相关性和分层回归模型检查了基线症状严重程度作为预测随访临床结局的指标。全脑分析检查了神经奖励过程与随访结果之间的关系。
在临床上，快感缺失而不是易怒，预测了未来的抑郁和自杀意念。在奖励过程中，只有在 PPE 期间的基线神经激活与随访的抑郁和快感缺失严重程度相关。具体而言，左侧角回（默认模式网络的一部分）的激活与未来的抑郁有关，而背侧前扣带皮层、脑岛的背外侧部和左侧岛叶（关键的突显和疼痛网络区域）的激活与未来的快感缺失有关，即使在控制了基线快感缺失的情况下也是如此。
样本量小和随访时间间隔的变化限制了结论的普遍性。
这项研究表明，奖励功能障碍（以快感缺失为指标）可能预测抑郁青少年的临床结局更差。表现出明显快感缺失的青少年应仔细监测疾病进展。
