Giles Michael A, Cooper Crystal M, Jha Manish K, Chin Fatt Cherise R, Pizzagalli Diego A, Mayes Taryn L, Webb Christian A, Greer Tracy L, Etkin Amit, Trombello Joseph M, Chase Henry W, Phillips Mary L, McInnis Melvin G, Carmody Thomas, Adams Phillip, Parsey Ramin V, McGrath Patrick J, Weissman Myrna, Kurian Benji T, Fava Maurizio, Trivedi Madhukar H
Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Behav Sci (Basel). 2023 Jul 25;13(8):619. doi: 10.3390/bs13080619.
The probabilistic reward task (PRT) has identified reward learning impairments in those with major depressive disorder (MDD), as well as anhedonia-specific reward learning impairments. However, attempts to validate the anhedonia-specific impairments have produced inconsistent findings. Thus, we seek to determine whether the Reward Behavior Disengagement (RBD), our proposed economic augmentation of PRT, differs between MDD participants and controls, and whether there is a level at which RBD is high enough for depressed participants to be considered objectively disengaged. Data were gathered as part of the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study, a double-blind, placebo-controlled clinical trial of antidepressant response. Participants included 195 individuals with moderate to severe MDD (Quick Inventory of Depressive Symptomatology (QIDS-SR) score ≥ 15), not in treatment for depression, and with complete PRT data. Healthy controls ( = 40) had no history of psychiatric illness, a QIDS-SR score < 8, and complete PRT data. Participants with MDD were treated with sertraline or placebo for 8 weeks (stage I of the EMBARC trial). RBD was applied to PRT data using discriminant analysis, and classified MDD participants as reward task engaged ( = 137) or reward task disengaged ( = 58), relative to controls. Reward task engaged/disengaged groups were compared on sociodemographic features, reward-behavior, and sertraline/placebo response (Hamilton Depression Rating Scale scores). Reward task disengaged MDD participants responded only to sertraline, whereas those who were reward task engaged responded to sertraline and placebo ((1293) = 4.33, = 0.038). Reward task engaged/disengaged groups did not differ otherwise. RBD was predictive of reward impairment in depressed patients and may have clinical utility in identifying patients who will benefit from antidepressants.
概率性奖励任务（PRT）已确定重度抑郁症（MDD）患者存在奖励学习障碍，以及快感缺失特异性奖励学习障碍。然而，验证快感缺失特异性障碍的尝试产生了不一致的结果。因此，我们试图确定奖励行为脱离（RBD），即我们提出的PRT的经济增强版，在MDD参与者和对照组之间是否存在差异，以及是否存在一个RBD水平，高到足以使抑郁参与者被视为客观脱离。数据是作为临床护理中抗抑郁反应的调节因素和生物标志物确立（EMBARC）研究的一部分收集的，这是一项关于抗抑郁反应的双盲、安慰剂对照临床试验。参与者包括195名中度至重度MDD患者（抑郁症状快速自评量表（QIDS-SR）评分≥15），未接受抑郁症治疗，且有完整的PRT数据。健康对照组（n = 40）无精神疾病史，QIDS-SR评分<8，且有完整的PRT数据。MDD参与者接受舍曲林或安慰剂治疗8周（EMBARC试验的第一阶段）。使用判别分析将RBD应用于PRT数据，并将MDD参与者相对于对照组分类为奖励任务参与组（n = 137）或奖励任务脱离组（n = 58）。比较奖励任务参与/脱离组在社会人口学特征、奖励行为和舍曲林/安慰剂反应（汉密尔顿抑郁量表评分）方面的差异。奖励任务脱离的MDD参与者仅对舍曲林有反应，而奖励任务参与的参与者对舍曲林和安慰剂均有反应（t(1293) = 4.33，p = 0.038）。奖励任务参与/脱离组在其他方面没有差异。RBD可预测抑郁症患者的奖励障碍，可能在识别将从抗抑郁药中获益的患者方面具有临床效用。
