1
|
Song X, Niu L, Admon R, Long J, Li Q, Peng L, Lee TM, Zhang R. Aberrant positive affect dynamics in individuals with subthreshold depression: Evidence from laboratory and real-world assessments. Int J Clin Health Psychol 2024; 24:100427. [PMID: 38173985 PMCID: PMC10761788 DOI: 10.1016/j.ijchp.2023.100427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
Background/Objective Reduced positive affect (PA) is a core feature of major depressive disorder (MDD). However, the precursor of MDD, subthreshold depression (StD), has received less attention in this regard. Therefore, we examined PA dynamics in StD, integrating laboratory-based and ecological momentary assessment (EMA) approaches. Method Participants were college students recruited from Chinese universities (31 with StD, and 39 healthy controls (HC)). Positive mood was induced in the laboratory by an eight-minute comedy clip used to assess PA reactivity and maintenance. To extend findings to the real world and explore mechanisms of PA maintenance, 53 participants with StD and 64 HC reported their emotional states 14 times daily for one week via EMA. Multilevel models were used to test for predictors of PA inertia. Results In the laboratory, participants with StD achieved the same PA reactivity as HC when facing positive stimuli, yet the curve-fitting revealed difficulties for the StD group in maintaining PA over time. Such reduced capacity was further observed in real-world settings, manifesting in significantly greater PA inertia. Conclusions High PA inertia in daily life may reflect resistance to mood change in StD, explaining anhedonia and difficulties with emotional maintenance, and highlighting the need for early identification.
Collapse
Affiliation(s)
- Xiaoqi Song
- Cognitive control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Lijing Niu
- Cognitive control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Roee Admon
- School of Psychological Sciences, University of Haifa, Haifa, Israel
- The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel
| | - Jixin Long
- Cognitive control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Qian Li
- Cognitive control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Lanxin Peng
- Cognitive control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Tatia M.C. Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, SAR China
- Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong, SAR China
- Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong-Macao Greater Bay Area, Guangzhou, China
| | - Ruibin Zhang
- Cognitive control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
- Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong-Macao Greater Bay Area, Guangzhou, China
- Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
2
|
Barber KE, Zainal NH, Newman MG. The mediating effect of stress reactivity in the 18-year bidirectional relationship between generalized anxiety and depression severity. J Affect Disord 2023; 325:502-512. [PMID: 36642311 PMCID: PMC9930685 DOI: 10.1016/j.jad.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) and major depressive disorder (MDD) often precede and predict one another. Heightened stress reactivity may be a mediation mechanism underlying the long-term connections between GAD and MDD. However, cross-sectional studies on this topic have hindered directional inferences. METHOD The present study examined stress reactivity as a potential mediator of the sequential associations between GAD and MDD symptoms in a sample of 3,294 community-dwelling adults (M age = 45.6, range = 20-74). Participants completed three waves of measurement (T1, T2, and T3) spaced nine years apart. GAD and MDD symptom severity were assessed at T1, T2, and T3 (Composite International Diagnostic Interview-Short Form). Stress reactivity (Multidimensional Personality Questionnaire) was measured at T2. RESULTS Structural equation mediation modeling demonstrated that higher T1 GAD symptoms positively predicted more severe T3 MDD symptoms via T2 stress reactivity, controlling for T1 MDD (d = 0.45-0.50). However, T2 stress reactivity was not a significant mediator in the relationship between T1 MDD severity and T3 GAD symptoms after controlling for T1 GAD. Direct effects indicated that T1 GAD positively predicted T3 MDD 18 years later and vice versa (d = 1.29-1.65). LIMITATIONS Stress reactivity was assessed using a self-report measure, limiting conclusions to perceived (vs. physiologically indexed) stress reactivity. CONCLUSIONS These findings indicate that stress reactivity may be one mechanism through which GAD leads to later MDD over prolonged durations. Overall, results suggest that targeting stress reactivity in treatments for GAD may reduce the risk of developing subsequent MDD.
Collapse
Affiliation(s)
- Kathryn E Barber
- Department of Psychology, Marquette University, United States of America; Department of Psychology and Psychiatry, The Pennsylvania State University, United States of America.
| | - Nur Hani Zainal
- Department of Public Health, Harvard Medical School, United States of America
| | - Michelle G Newman
- Department of Psychology and Psychiatry, The Pennsylvania State University, United States of America
| |
Collapse
|
3
|
Vehlen A, Kellner A, Normann C, Heinrichs M, Domes G. Reduced eye gaze during facial emotion recognition in chronic depression: Effects of intranasal oxytocin. J Psychiatr Res 2023; 159:50-56. [PMID: 36657314 DOI: 10.1016/j.jpsychires.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/21/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Chronic depression disorders (CDD) are characterized by impaired social cognitive functioning. Visual attention during social perception is altered in clinical depression and is known to be sensitive to intranasal treatment with oxytocin (OT). The present study thus investigated potential alterations in gaze preferences during a standardized facial emotion recognition (FER) task using remote eye tracking in patients with CDD and the effect of a single dose of intranasal OT (compared to placebo). In emotion recognition, CDD patients were not more impaired than healthy controls, and there was no OT effect. However, CDD patients (with placebo) demonstrated less attentional preference for the eye region during FER than healthy controls, which was not apparent in the CDD group after OT treatment. Our results suggest that despite largely preserved basic facial emotions recognition, attention in social perception may be altered in CDD, and that this bias may be sensitive to OT treatment. These findings highlight OTs potential as a means of augmenting psychotherapy.
Collapse
Affiliation(s)
- Antonia Vehlen
- Department of Biological and Clinical Psychology, University of Trier, Germany
| | - Antonia Kellner
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Center for Neuromodulation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Heinrichs
- Department of Psychology, Laboratory for Biological Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Germany
| | - Gregor Domes
- Department of Biological and Clinical Psychology, University of Trier, Germany.
| |
Collapse
|
4
|
Lovette AJ, Gabruk ME, Zhang Y, Mick CR, Wilson RA, Olatunji BO, Cole DA. Anxiety as a Predictor of Emotional and Cognitive Reactivity both Within and Between People. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10350-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
|
5
|
Fadiji AW, Chigeza S, Kgopa B. Who does better on life satisfaction and meaning in life? A Mixed-methods exploration of demographic characteristics and well-being in Ghana. JOURNAL OF PSYCHOLOGY IN AFRICA 2023. [DOI: 10.1080/14330237.2023.2175961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
|
6
|
Sun CW, Yan C, Lv QY, Wang YJ, Xiao WY, Wang Y, Yi ZH, Wang JK. Emotion Context Insensitivity is generalized in individuals with major depressive disorder but not in those with subclinical depression. J Affect Disord 2022; 313:204-213. [PMID: 35777495 DOI: 10.1016/j.jad.2022.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/02/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Depressed individuals experience deficits in emotional reactivity. One well-established theory is the Emotion Context Insensitivity (ECI) theory. To better understand impairments in emotional reactivity, we investigated whether the ECI theory is applicable to anticipatory, consummatory, and remembered affect, in both clinical and subclinical depression. METHODS Participants were divided into four groups: Major Depressive Disorder Group (MDD, N = 60), Control Group for MDD (ControlMDD, N = 50), Subclinical Depression Group (SD, N = 56), and Control Group for SD (ControlSD, N = 56). The Hamilton Depression Rating Scale and the Beck Depression Inventory were used to assess the severity of depression and anhedonia symptoms. The Monetary Incentive Delay Task evaluated participants' affective responses towards monetary stimuli. RESULTS The MDD group was more insensitive to both monetary reward and loss across most types of affect than was the control group. Compared with the controls, the SD group exhibited lower reactivity in anticipatory positive affect but enhanced reactivity in consummatory positive, anticipatory, and remembered negative affect. LIMITATIONS Emotional affect was evaluated by subjective ratings, which may lack objectivity. Additionally, laboratory settings and monetary rewards used in this study may cause the results less generalized to daily life and to other types of rewards. CONCLUSION The pattern of emotional reactivity in the MDD group was partly consistent with the ECI theory, whereas the SD group showed greater arousal and instability of emotional reactions. These different patterns could facilitate the understanding of emotional reactivity and develop further treatments across the course of depression.
Collapse
Affiliation(s)
- Ching-Wen Sun
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Shanghai Changning Mental Health Center, Shanghai, China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Shanghai Changning Mental Health Center, Shanghai, China.
| | - Qin-Yu Lv
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ya-Jing Wang
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Wen-Yi Xiao
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Zheng-Hui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ji-Kun Wang
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.
| |
Collapse
|
7
|
Guhn A, Merkel L, Heim C, Klawitter H, Teich P, Betzler F, Sterzer P, Köhler S. Impaired empathic functioning in chronic depression: Behavioral evidence for the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) model. J Psychiatr Res 2022; 152:79-85. [PMID: 35716512 DOI: 10.1016/j.jpsychires.2022.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/19/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) model proposes preoperational functioning as a core feature of persistent depressive disorders (PDD). Empathy deficits comprise one aspect. Resulting from childhood maltreatment, empathy deficits may aggravate social isolation, a key factor in the maintenance of depression. CBASP targets empathy by teaching patients to disengage from past experiences and to engage successfully in present social interactions. However, behavioral evidence for empathy deficits in PDD has remained elusive. We reasoned that deficits become apparent only under stress and that these deficits improve after CBASP-treatment. Twenty-two patients and 21 controls performed two parallel versions of the Multifaceted Empathy Test. For stress induction, a negative autobiographical event was presented before performing the task. A neutral event served as control. Fifteen patients performed the experiment twice, before and after a 12-week inpatient CBASP-treatment. Supporting our hypotheses, patients showed reduced empathy under stress, while no group difference was found in the absence of stress. Reduced empathy correlated with the level of re-experiencing negative memories. Pre-post-treatment comparison revealed that the stress-induced empathy deficit improved in patients over time. Post-treatment empathic capacity correlated positively with clinical improvement. Our findings provide empirical support for the CBASP model, but highlight an important new aspect: Empathy is not generally deficient in PDD but becomes impaired under stress. In real-life situations, stress-induced empathy impairments may exacerbate interpersonal conflicts. CBASP's interpersonal focus improved empathy, accompanied by clinical improvement as the model predicts.
Collapse
Affiliation(s)
- Anne Guhn
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany.
| | - Lydia Merkel
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany
| | - Christine Heim
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Charitéplatz 1, 10117, Berlin, Germany
| | - Heiko Klawitter
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Charitéplatz 1, 10117, Berlin, Germany
| | - Paula Teich
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Betzler
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany
| | - Philipp Sterzer
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany
| | - Stephan Köhler
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Neurosciences, Charitéplatz 1, 10117, Berlin, Germany
| |
Collapse
|
8
|
Köhler S, Weilnhammer VA, Walter H, Erk S, Sterzer P, Guhn A. Autobiographical Script-Driven Imagery Has No Detectable Effect on Emotion Regulation in Healthy Individuals. Neuropsychobiology 2022; 81:141-148. [PMID: 34571510 DOI: 10.1159/000518996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Emotion regulation (ER), the ability to actively modulate one's own emotion reactions, likely depends on the individual's current emotional state. Here, we investigated whether negative emotions induced by an interpersonal autobiographic script affect the neuronal processes underlying ER. METHODS Twenty healthy participants were recruited and underwent functional magnetic resonance imaging (fMRI) during performance of distancing, a specific ER strategy, while viewing emotionally arousing pictures. Participants were instructed to either naturally experience ("permit" condition) or to actively downregulate ("regulate" condition) their emotional responses to the presented stimuli. Before each of the 4 runs in total, a neutral or negative autobiographical audio script was presented. The negative script comprised an emotionally negative event from childhood or adolescence that represented either emotional abuse or emotional neglect. The second event comprised an everyday neutral situation. We aimed at identifying the neural correlates of ER and their modulation by script-driven imagery. RESULTS fMRI analyses testing for greater responses in the "regulate" than the "permit" condition replicated previously reported neural correlates of ER in the right dorsolateral prefrontal cortex and the right inferior parietal lobule. A significant ER effect was also observed in the left orbitofrontal cortex. In the amygdala, we found greater responses in the "permit" compared to the "regulate" condition. We did not observe a significant modulation of the ER effects in any of these regions by the negative emotional state induced by autobiographical scripts. Bayesian statistics confirmed the absence of such modulations by providing marginal evidence for null effects. DISCUSSION While we replicated previously reported neural correlates of ER, we found no evidence for an effect of mood induction with individualized autobiographical scripts on the neural processes underlying ER in healthy participants.
Collapse
Affiliation(s)
- Stephan Köhler
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Veith Andreas Weilnhammer
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Charité-Universitätsmedizin Berlin and Max Delbrück Center, Berlin, Germany
| | - Henrik Walter
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susanne Erk
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Philipp Sterzer
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Bernstein Center of Computational Neuroscience, Berlin, Germany
| | - Anne Guhn
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
9
|
|
10
|
Rackoff GN, Newman MG. Reduced positive affect on days with stress exposure predicts depression, anxiety disorders, and low trait positive affect 7 years later. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 129:799-809. [PMID: 32914995 PMCID: PMC8048702 DOI: 10.1037/abn0000639] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Positive emotions serve important functions for mental health. Susceptibility to reduced positive emotions in the context of stress may increase risk for poor mental health outcomes, including anxiety and depressive disorders and low overall levels of positive emotion. In an 8-day daily diary study within a larger panel study (N = 1,517), we tested whether degree of reduction in time spent experiencing positive affect on days of stress exposure predicted lower levels of positive affect and elevated risk for major depressive and anxiety disorders (generalized anxiety disorder or panic disorder) 7 years later. Bayesian multilevel structural equation modeling controlling for overall levels of affect, stress exposure, leisure time, sex, age, and past year diagnoses of depression and anxiety disorders was conducted. Participants, on average, reported less time experiencing positive affect on days with stressors compared to days without stressors. In addition, participants varied in the extent to which their time spent experiencing positive affect differed across days with and without stressors. Those who reported an especially reduced proportion of the day experiencing positive affect on days with stressors also experienced lower positive affect and greater risk for major depressive disorder and anxiety disorders 7 years later. These prospective associations suggest that between-person differences in the within-person association between stress and positive emotions have implications for mental health years later. The efficacy of preventive interventions could be improved by fostering resilience of positive emotions during common stressful events. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
|
11
|
Guhn A, Merkel L, Hübner L, Dziobek I, Sterzer P, Köhler S. Understanding versus feeling the emotions of others: How persistent and recurrent depression affect empathy. J Psychiatr Res 2020; 130:120-127. [PMID: 32805521 DOI: 10.1016/j.jpsychires.2020.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 12/19/2022]
Abstract
Empathy refers to the ability to understand the emotions of others. It encompasses a cognitive component of decoding a mental state, and an affective component that relates to an emotional response. Deficits in empathy have been associated with social dysfunction in depression. It is further assumed that impairments are aggravated when depression takes a chronic course. Existing evidence in the literature, however, is scarce and heterogeneous. The present study investigated empathy in patients with persistent and recurrent depression as well as in healthy controls (N = 102). Empathy measurements included both self-report (Interpersonal Reactivity Index, IRI) as well as a laboratory task (Multifaceted Empathy Task, MET). A mixed model analyses of covariance, which accounted for differences in executive functioning, found no evidence for impaired cognitive empathy in depression. All three groups performed equally well in understanding mental states. However, both IRI and MET confirmed the hypothesis of significant deficits in affective empathy. Patients reported higher personal distress than controls, and showed lower affective responses towards positive emotions in others. There was no difference between patient groups. Childhood maltreatment was further related to reduced affective empathy. The present results contribute to our understanding of social dysfunction in depression, since loss of emotional reactivity to the feelings of others is considered to reduce the desire to engage in social interaction, thus leading to isolation and aggravation of depression.
Collapse
Affiliation(s)
- Anne Guhn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany.
| | - Lydia Merkel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany
| | - Laura Hübner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany
| | - Isabel Dziobek
- Humboldt Universität zu Berlin, Department of Psychology, Clinical Psychology of Social Interaction, Berlin, Germany
| | - Philipp Sterzer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany
| | - Stephan Köhler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany
| |
Collapse
|
12
|
Michely J, Eldar E, Martin IM, Dolan RJ. A mechanistic account of serotonin's impact on mood. Nat Commun 2020; 11:2335. [PMID: 32393738 PMCID: PMC7214430 DOI: 10.1038/s41467-020-16090-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/08/2020] [Indexed: 01/31/2023] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) constitute a first-line antidepressant intervention, though the precise cognitive and computational mechanisms that explain treatment response remain elusive. Using week-long SSRI treatment in healthy volunteer participants, we show serotonin enhances the impact of experimentally induced positive affect on learning of novel, and reconsolidation of previously learned, reward associations. Computational modelling indicated these effects are best accounted for by a boost in subjective reward perception during learning, following a positive, but not negative, mood induction. Thus, instead of influencing affect or reward sensitivity directly, SSRIs might amplify an interaction between the two, giving rise to a delayed mood response. We suggest this modulation of affect-learning dynamics may explain the evolution of a gradual mood improvement seen with these agents and provides a novel candidate mechanism for the unfolding of serotonin’s antidepressant effects over time. The cognitive computational mechanisms underlying the antidepressant treatment response of SSRIs is not well understood. Here the authors show that SSRI treatment in healthy subjects for a week manifests as an amplification of the perception of positive outcomes when learning occurs in a positive mood setting.
Collapse
Affiliation(s)
- Jochen Michely
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK. .,Wellcome Centre for Human Neuroimaging, University College London, London, UK. .,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Eran Eldar
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK.,Psychology and Cognitive Sciences Departments, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ingrid M Martin
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Raymond J Dolan
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK.,Wellcome Centre for Human Neuroimaging, University College London, London, UK
| |
Collapse
|
13
|
Nübel J, Guhn A, Müllender S, Le HD, Cohrdes C, Köhler S. Persistent depressive disorder across the adult lifespan: results from clinical and population-based surveys in Germany. BMC Psychiatry 2020; 20:58. [PMID: 32041560 PMCID: PMC7011512 DOI: 10.1186/s12888-020-2460-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/23/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Although the individual and economic disease burden of depression is particularly high for long-term symptoms, little is known of the lifetime course of chronic depression. Most evidence derives from clinical samples, and the diagnostic distinction between persistent depressive disorder (PDD) and non-chronic major depression (NCMDD) is still debated. Thus, we examined characteristics of PDD among clinical vs. non-clinical cases, and the associated disease burden at a population level. METHODS Data were drawn from the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009-2012, n = 4483) and a clinical sample of PDD inpatients at Charité - Universitätsmedizin Berlin (2018-2019, n = 45). The DSM-5 definition of PDD was operationalized a priori to the study using interview-based DSM-IV diagnoses of dysthymia and major depression lasting at least 2 years in both surveys. Additional depression characteristics (depression onset, self-classified course, suicidality, comorbid mental disorders, treatment history and current depressive symptoms [Patient Health Questionnaire-9]) were assessed. In the DEGS1-MH, health-related quality of life (Short Form Health Survey-36, SF-36), chronic somatic conditions, number of sick days (past 12 months) or days with limitations in normal daily life activities (past 4 weeks), and health service utilization (past 12 months) were compared for PDD vs. NCMDD. RESULTS PDD cases from the clinical sample had a significantly earlier depression onset, a higher proportion of self-classification as persistent course, and treatment resistance than PDD and NCMDD cases in DEGS1-MH. At a population level, PDD cases showed worse outcomes compared with NCMDD cases in terms of somatic comorbidity, SF-36 mental component score, and activity limitations owing to mental health problems, as well as a higher risk for outpatient mental health care contact. CONCLUSIONS The distinction between PDD and NCMDD proposed for DSM-5 seems warranted. Early onset depression, self-classification as persistent depressive course, and treatment resistance are suggested as markers of more severe and chronic depression courses. At a population level, PDD is associated with remarkably higher individual and economic disease burden than NCMDD, highlighting the need to improve medical recognition of chronic courses and establish specific treatment concepts for chronic depression.
Collapse
Affiliation(s)
- Julia Nübel
- Department of Epidemiology and Health Monitoring, Unit 26 Mental Health, Robert Koch Institute, PO Box 650261, 13302 Berlin, Germany
| | - Anne Guhn
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Susanne Müllender
- Department of Epidemiology and Health Monitoring, Unit 26 Mental Health, Robert Koch Institute, PO Box 650261, 13302 Berlin, Germany
| | - Hong Duyen Le
- Department of Epidemiology and Health Monitoring, Unit 26 Mental Health, Robert Koch Institute, PO Box 650261, 13302 Berlin, Germany
| | - Caroline Cohrdes
- Department of Epidemiology and Health Monitoring, Unit 26 Mental Health, Robert Koch Institute, PO Box 650261, 13302 Berlin, Germany
| | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
14
|
Wang X, Cui S, Wu MS, Wang Y, Gao Q, Zhou Y. Victim Sensitivity and Its Neural Correlates Among Patients With Major Depressive Disorder. Front Psychiatry 2020; 11:622. [PMID: 32848898 PMCID: PMC7432150 DOI: 10.3389/fpsyt.2020.00622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dysfunctional beliefs about the self are common in the development of depressive symptoms, but it remains unclear how depressed patients respond to unfair treatment, both dispositionally and neurally. The present research is an attempt to explore the differences in sensitivity to injustice as a victim and its neural correlates in patients with major depressive disorder (MDD) versus healthy controls. METHODS First episodic, drug-naïve patients with MDD (n = 30) and a control group (n = 30) were recruited to compare their differences in victim sensitivity. A second group of patients with MDD (n = 23) and their controls (n = 28) were recruited to replicate the findings and completed resting-state functional magnetic resonance imaging (fMRI) scanning. Spontaneous brain activity measured by fractional amplitude of low-frequency fluctuation (fALFF) was used to characterize the neural correlates of victim sensitivity both in patients and in healthy controls. RESULTS Higher victim sensitivity was consistently found in patients with MDD than healthy controls in both datasets. Multiple regression analysis on the fALFF showed a significant interaction effect between diagnosis and victim sensitivity in the right dorsolateral prefrontal cortex (DLPFC). CONCLUSIONS The patients with MDD show higher sensitivity to injustice as a victim, which may be independent of their disease course. The MDD patients differ from healthy controls in the neural correlates of victim sensitivity. These findings shed light on the linkage between cognitive control subserved by the DLPFC and negative bias towards the self implicated by higher victim sensitivity among the depressed patients.
Collapse
Affiliation(s)
- Xiaoming Wang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Shaojuan Cui
- Department of Psychology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | | | - Yun Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Qinglin Gao
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuan Zhou
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
15
|
Guhn A, Steinacher B, Merkl A, Sterzer P, Köhler S. Negative mood induction: Affective reactivity in recurrent, but not persistent depression. PLoS One 2019; 14:e0208616. [PMID: 30645583 PMCID: PMC6333350 DOI: 10.1371/journal.pone.0208616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/20/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite the high clinical and epidemiological relevance of persistent depression, little is known about its specific psychopathology and whether it is distinct from recurrent depression. Depression in general has been associated with blunted affective reactivity but the evidence from previous studies is inconsistent. Here, we asked whether affective reactivity might differ between persistent and recurrent depression. METHODS Twenty patients with persistent depression, 20 patients with recurrent depression and 20 healthy controls (HC) were recruited. Both patient groups showed moderate symptom severity. All participants underwent a sad mood induction procedure. Affective reactivity was assessed with the Positive and Negative Affect Schedule (PANAS) before and after mood induction. RESULTS We found a striking difference in affective reactivity between patient groups. While the persistent group showed blunted reactivity to mood induction, the recurrent group demonstrated an affective response that was comparable to HC, with an increase in negative and a decrease in positive affect. Blunted affective reactivity was thus specifically associated with persistent in contrast to recurrent depression. CONCLUSIONS These results highlight affective reactivity as an important psychopathological feature that differs between the two patient groups. Preserved affective reactivity to emotional stimuli in the recurrent group might reflect a resilience factor against persistence of depression.
Collapse
Affiliation(s)
- Anne Guhn
- Department of Psychiatry and Psychotherapy, Charité –Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Bruno Steinacher
- Department of Psychiatry and Psychotherapy, Vivantes GmbH Wenckebach-Hospital, Berlin, Germany
| | - Angela Merkl
- Department of Psychiatry and Psychotherapy, Charité –Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- Fliedner Clinic Berlin, Outpatient Clinic for Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Charité –Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité –Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| |
Collapse
|
16
|
Köhler S, Chrysanthou S, Guhn A, Sterzer P. Differences between chronic and nonchronic depression: Systematic review and implications for treatment. Depress Anxiety 2019; 36:18-30. [PMID: 30300454 DOI: 10.1002/da.22835] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/20/2018] [Accepted: 08/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is still uncertainty if and to what extent chronic depression (CD) presents with specific features especially in contrast to the nonchronic course of major depressive disorder (non-CD). This systematic review aims to summarize the existing literature regarding sociodemographic factors, psychopathology, and course of disease in patients with CD in comparison to patients with non-CD. METHODS A structured database search (MEDLINE, PsycINFO, Web of Science, CENTRAL) was performed. All studies comparing CD with non-CD patients were included. Twenty-eight studies, including cohort studies, cross-sectional studies, and observational studies, were identified in which both subgroups were diagnosed according to DSM-IV or DSM-5, respectively. Primary outcome were group comparisons focused on sociodemographic factors, childhood adversity, onset of the disorder, comorbidities, severity and course of the depressive symptoms, and specific psychopathology. RESULTS Patients with CD had an earlier onset of depressive symptoms, higher rates of psychiatric comorbidities, and a complicated treatment course (e.g., higher rates of suicidality) compared to non-CD. We also found some evidence for specific features in the psychopathology of CD patients (submissive and hostile interpersonal styles) in contrast to non-CD patients. Results were inconsistent with regard to childhood maltreatment. No differences were found regarding the severity of depressive symptoms and most sociodemographic factors. CONCLUSION Despite some inconsistencies, the results of this review verified important differences between CD and non-CD. However, future research is needed to characterize especially the specific psychopathology of CD in comparison to non-CD patients to develop more tailored treatment strategies.
Collapse
Affiliation(s)
- Stephan Köhler
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Sophia Chrysanthou
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Anne Guhn
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| |
Collapse
|