Context insensitivity during positive and negative emotional expectancy in depression assessed with functional magnetic resonance imaging

Social impression formation and depression: examining cognitive flexibility and bias

Depression is associated with a bias toward negative interpretations of social situations and resistance to integrating evidence consistent with positive interpretations. These features could contribute to social isolation by generating negative expected value for future social interactions. The present study examined potential associations between depressive symptoms and positive (i.e. trust and liking) and negative (i.e. distrust and disliking) social impression formation of individuals who previously appeared in positive or negative contexts. Participants (N = 213) completed the Interpretation Inflexibility Task and were subsequently asked to provide social impression ratings of characters from each scenario type of the task (i.e. positive and negative) as well as characters not previously encountered. In examining social impression formation, higher severity of depressive symptoms was associated with higher negative social impression ratings regardless of scenario outcome, as well as lower positive social impression ratings, but only for characters who previously appeared in positive contexts. Those higher in depression also rated novel characters as significantly more unlikeable and untrustworthy and to an equivalent degree as the characters previously encountered. These findings suggest a role of negative interpretation bias and inflexibility in contributing to negative evaluations of potential social interaction partners in depression.

Depressive symptoms are associated with reduced positivity preferences in episodic memory in aging

Age-related positivity preferences are represented as greater memory benefits for positive and/or reduced benefits for negative material with age. It is unknown if positivity preferences are limited to older adults without depressive symptoms. In this fMRI study, adults across the lifespan with a range of depressive symptoms were scanned as they rated emotional intensity of images and subsequently completed a recognition memory task. Behavioral, univariate, and functional connectivity analyses provided evidence for interactive effects between age and depressive symptoms. With low depressive symptoms, typical age-related emotional preferences emerged: younger age was associated with better memory for negative images, and this benefit was reduced with older age. With increasing depressive symptoms in older age, positivity preferences were reduced, manifesting as improvements in negative memory. The neural data highlighted potential underlying mechanisms, including reductions in prefrontal cortex connectivity reflecting diminished ability to engage regulatory processes to reduce negative affect in older participants with higher depressive symptoms. These findings suggest that depressive symptoms in older adulthood reduce positivity preferences through alterations in neural networks underlying emotion regulation.

Anticipatory cues in emotional processing shift the activation of a combined salience sensorimotor functional network in drug-naïve depressed patients

BACKGROUND

Major depressive disorder is characterized by a large-scale brain network dysfunction, contributing to impairments in cognitive and affective functioning. Core regions of default mode, limbic and salience networks are also impaired in emotional processing and anticipation. This study aimed to explore default mode, salience, and limbic networks modulation during the processing of emotional stimuli with and without anticipatory cues in depression, and further investigate how these networks were functionally coupled with the rest of the brain.

METHODS

Twenty-one drug-naïve depressed patients and 15 matched controls were included in the study. All participants completed a psychological assessment and the affective pictures paradigm during an fMRI acquisition. Group independent component analysis and psychophysiological interactions analyses were performed.

RESULTS

A significant interaction between Cue, Valence and Group was found for the salience/sensorimotor network. When processing uncued emotional stimuli, patients showed increased activation of this network for negative vs. neutral pictures, whereas when anticipatory cues were displayed previously to the picture presentation, they invert this pattern of activation (hyperactivating the salience/sensorimotor network for positive vs. neutral pictures). Patients showed increased functional connectivity between the salience/sensorimotor network and the left amygdala as well as the right inferior parietal lobule compared to controls when processing uncued negative pictures.

LIMITATIONS

The sample size was modest, and the salience/sensorimotor network included regions not typically identified as part of salience network. Thus, this study should be replicated to further interpret the results.

CONCLUSIONS

Anticipatory cues shift the pattern of activation of the salience/sensorimotor network in drug-naïve depressed patients.

Emotion Context Insensitivity is generalized in individuals with major depressive disorder but not in those with subclinical depression

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 (Control_MDD, N = 50), Subclinical Depression Group (SD, N = 56), and Control Group for SD (Control_SD, 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.

Increased prefrontal cortex connectivity associated with depression vulnerability and relapse

BACKGROUND

Major depressive disorder (MDD) is a highly prevalent mood disorder, characterized by depressed mood, reduced capabilities to concentrate, impaired cognition, as well as a high risk of relapse. Unaffected siblings who have high risks for MDD development and yet without clinical symptoms may be helpful for understanding the neural mechanisms of MDD traits.

METHODS

We investigated both regional fluctuation and inter-regional synchronization in 31 fully remitted MDD patients, 29 unaffected siblings and 43 age, gender, and educational level matched helathy controls (HCs) using resting-state functional magnetic resonance imaging (rs-fMRI). The 17-item HAMD and neurocognitive scales were performed. Fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) strength were investigated.

RESULTS

Compared with healthy control group, patients with remitted MDD and unaffected siblings showed increased fALFF in the left dorsomedial prefrontal cortex (dmPFC) and increased FC between the left dmPFC and the right ventromedial prefrontal cortex (vmPFC). In addition, a negative correlation was observed between the fALFF value in the left dmPFC and the speed of Trail Making Test in the remitted MDD patients. Higher vmPFC-dmPFC FC was positively correlated with Wisconsin Card Sorting Test (WCST) total correct, and negatively correlated with WCST random errors.

CONCLUSIONS

In the absence of clinical symptoms, individuals with remitted MDD and unaffected siblings showed increased fALFF in left dmPFC as well as the vmPFC-dmPFC connectivity. These results suggest a specific trait abnormality in the default mode network associated with vulnerability to MDD, which may have implications for developing effective therapies using this network as a target.

Brain Activation During Processing of Depression Emotion in College Students With Premenstrual Syndrome in China: Preliminary Findings

BACKGROUND

This study aimed to investigate the neural substrates of processing depression emotion in premenstrual syndrome (PMS) and healthy subjects of college students using blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI).

METHODS

During BOLD-fMRI scanning, 13 PMS patients and 15 healthy controls (HC) performed a picture visual stimulation task during luteal and follicular phases, in which participants and HC were asked to see pictures containing depression and non-depression emotions. Simultaneously, self-rating depression scales (SDS) were employed to evaluate the emotional status of participants.

RESULTS

Compared to HC, right inferior occipital gyrus, right middle occipital gyrus, right lingual gyrus, right fusiform gyrus, right inferior temporal gyrus, cerebelum_crus1_R, cerebelum_6_R, culmen, the cerebellum anterior lobe, tuber, and cerebellar tonsil of PMS patients showed enhanced activation. In contrast, sub-lobar, sub-gyral, extra-nuclear, right orbit part of superior frontal gyrus, right middle temporal gyrus, right orbit part of inferior frontal gyrus, limbic lobe, right insula, bilateral anterior and adjacent cingulate gyrus, bilateral caudate, caudate head, bilateral putamen, and left globus pallidus exhibited decreased activation.

CONCLUSION

The findings indicate that abnormal functional regulation of brain regions such as occipital lobe and cerebellum leads to abnormal changes in emotional regulation, cognitive ability, and attention distribution in PMS patients, implying significant central pathogenesis.

Contextual goal-dependent attention flexibility or rule-based learning? An investigation of a new attention flexibility paradigm

BACKGROUND & OBJECTIVES

Deficits in the ability to process contextual changes have been proposed to be crucial for emotion dysregulation. A recent study found evidence for the role of contextual changes in exacerbating attention switching towards valence-specific goals using a novel attention flexibility paradigm. Despite the task indicating good reliability, the role of rule-based learning has not been clarified in this paradigm. Therefore, we examined whether the novel attention flexibility task is an index of context-based attention switching or does it reflect impact of rule-based learning on attention.

METHOD

We employed a neutral version of the attention flexibility task. A sample of dysphoric and non-dysphoric participants were introduced to neutral contexts which required them to shift between neutral categories of pictures depending upon the cueing shape.

RESULTS

There was an existence of a switch cost for shifting between different rules owing to the features of the rules. Further, non-dysphorics were faster at set-shifting between different rules as compared to dysphoric individuals. However, unlike in the affective version of the attention flexibility task, we found no significant differences between dysphoric and non-dysphoric individuals in attention switching patterns owing to switching between different rules.

LIMITATIONS

Although the current study aimed to replicate the design of the previous study, a depressed patient sample must be employed to further clarify the different aspects of the attention flexibility paradigm.

CONCLUSION

Our findings were able to clarify the non-existent role of rule-based learning in the attention flexibility paradigm.

Neural substrates for anticipation and consumption of social and monetary incentives in depression

Depression has been reliably associated with abnormalities in the neural representation of reward and loss. However, most studies have focused on monetary incentives; fewer studies have considered neural representation of social incentives. A direct comparison of non-social and social incentives within the same study would establish whether responses to the different incentives are differentially affected in depression. The functional magnetic resonance imaging study presented here investigated the neural activity of individuals with subthreshold depression (SD) and healthy controls (HCs) while they participated in an incentive delay task offering two types of reward (monetary gain vs social approval) and loss (monetary loss vs social disapproval). Compared to HCs, individuals with SD showed increased subgenual anterior cingulate cortex (sgACC) activity during anticipation of social loss, whereas the response in the putamen was decreased during consumption of social gain. Individuals with SD also exhibited diminished insula responses in consuming social loss. Furthermore, positive connectivity between the insula and ventral lateral pre-frontal cortex (VLPFC) was observed in individuals with SD while negative connectivity was found in HCs when consuming social loss. These results demonstrate neural alterations in individuals with depression, specific to the processing of social incentives, mainly characterised by dysfunction within the ‘social pain network’ (sgACC, insula and VLPFC).

Gray Matter Volume Reductions Were Associated with TPH1 Polymorphisms in Depressive Disorder Patients with Suicidal Attempts

OBJECTIVE

Structural changes of brain areas have been reported in depressive disorder and suicidal behavior (SB), in which TPH1 also has been known as a promising candidate gene. We investigated gray matter volume (GMV) differences, TPH1 rs1800532 and rs1799913 polymorphisms previously found to be associated with depressive disorder and SB, and the relationship between the two markers.

METHODS

Thirteen depressive disorder patients with suicidal attempts (SA) and twenty healthy controls were included. We examined GMV differences using a voxel-based morphometry and regions of interest analysis. Direct sequencing was used for genotyping.

RESULTS

The patients showed significant GMV reduction in left cerebral region including middle frontal gyrus, inferior frontal gyrus, and anterior cingulate cortex; in right middle temporal gyrus; in left cerebellar tonsil; and in right cerebral region including precentral gyrus and postcentral gyrus (corrected p<0.005). The right precentral and postcentral gyri GMV values of AA and CA genotypes patients were significantly decreased compared to those of CC genotype subjects (corrected p=0.040).

CONCLUSION

These findings show the possibility that both GMV reductions and TPH1 rs1800532/rs1799913 A allele may be involved in the pathogenesis of depressive disorder patients with SA.

Decreased Functional Connectivity in Insular Subregions in Depressive Episodes of Bipolar Disorder and Major Depressive Disorder

Objective: Clinically, it is very difficult to distinguish between major depressive disorder (MDD) and bipolar disorder (BD) in the period of depression. Increasing evidence shows that the insula plays an important role in depression. We aimed to compare the resting-state functional connectivity (rsFC) of insular subregions in patients with MDD and BD in depressive episodes (BDD), who had never experienced manic or hypomanic episodes when they were scanned to identify biomarkers for the identification of two diseases. Methods: We recruited 21 BDD patients, 40 MDD patients and 70 healthy controls (HC). Resting-state functional magnetic resonance imaging (rs-fMRI) was performed. BDD patients had never had manic or hypomanic episodes when they were scanned, and the diagnoses were determined by follow-up. We divided the insula into three parts including the ventral anterior insular cortex (v-AIN), dorsal anterior insular cortex (d-AIN), and posterior insula (PI). The insular-based rsFC was compared among the three groups, and an analysis of the correlation between the rsFC value and Hamilton depression and anxiety scales was carried out. Results: BDD and MDD patients demonstrated decreased rsFC from the v-AIN to the left superior/middle frontal gyrus compared with the HC group. Versus MDD and HC groups, BDD patients exhibited decreased rsFC from the v-AIN to the area in the left orbital frontal gyrus and left superior temporal gyrus (included temporal pole), from the PI to the right lateral postcentral gyrus and from all three insular subregions to the somatosensory and motor cortex. Meanwhile, a correlation between the rsFC value of the PI-right lateral postcentral gyrus and anxiety score was observed in patients. Conclusion: Our findings show BDD and MDD patients have similar decreases in insular connectivity in the dorsal lateral frontal regions, and BDD patients have specific decreased insular connectivity, especially in the somatosensory and motor cortex, which may be used as imaging evidence for clinical identification.

Essential brain structural alterations in major depressive disorder: A voxel-wise meta-analysis on first episode, medication-naive patients

BACKGROUND

Because brain morphological abnormalities in major depressive disorder (MDD) may be modulated by medication and episodes, previous meta-analyses of voxel-based morphometry (VBM) studies therefore have been biased for including medicated patients or medication-free patients who had ever received drugs, as well as patients with different episodes. We sought to identify the essential morphological features without the interference of medication and episodes in MDD.

METHODS

Seed-based d Mapping was applied to analyze the gray matter differences between all first episode (FE), medication-naive MDD patients and healthy controls. Subgroup meta-analyses and meta-regression were used to explore the effects of methodology, demographics and clinical characteristics.

RESULTS

We identified 10 studies comprising 329 FE, medication-naive MDD patients and 340 healthy controls. Gray matter volumes were increased in the bilateral thalamus, cuneus, left paracentral lobule and medial superior frontal gyrus, and decreased in the right dorsolateral superior frontal gyrus, left insula and middle frontal gyrus in patients. Decreased volume in the right inferior temporal gyrus was only observed in patients with short illness duration and studies with threshold corrections. Moreover, there were different results between 3.0T MRI and 1.5T MRI studies. Meta-regression analyses revealed that mean age and the percentage of female patients were not significantly correlated with gray matter changes.

LIMITATIONS

There are heterogeneities in demographics, clinical features and analyzing methods of selected studies.

CONCLUSIONS

The present meta-analysis revealed that structural abnormalities in the fronto-limbic networks are the essential characteristics in MDD and could contribute to the high risk of suicide in patients.

Cognitive distortions mediate depression and affective response to social acceptance and rejection

BACKGROUND

The emotional context insensitivity (ECI) hypothesis suggests individuals with depression have blunted affective responses to both positive and negative events. We tested ECI in a social context to examine how depression relates to affective responses to social acceptance and rejection outcomes. Furthermore, we aimed to identify cognitive mechanisms linking depression with affective response to social feedback. Finally, we tested whether these processes are similar for social anxiety.

METHOD

90 participants (age 18-26 years; 53 women) completed the two-visit Chatroom task. At Visit 1 they rated their expectations about being liked by 60 peers. At Visit 2 they completed self-reports of depressive and social anxiety symptoms, and of cognitive flexibility, then received acceptance or rejection feedback from each peer and rated their affective response.

RESULTS

Greater depressive symptoms related to negative expectancy bias, lower cognitive flexibility, and less positive affective response to acceptance, but did not relate to rejection. Negative expectations and cognitive flexibility mediated the relationship between depressive symptoms and affective response for acceptance; only negative expectations mediated rejection responses. These cognitive mechanisms were not related to social anxiety.

LIMITATIONS

A community sample was used to assess depression. Rumination and current mood state were omitted as potential predictors of affective response.

CONCLUSIONS

Findings support the ECI framework. Depression but not social anxiety interferes with positive and negative affect through cognitively mediated dampening of emotional response to social acceptance and rejection. Emotion regulation strategies in depression therapy can target social flexibility to improve alignment of affective reactions to social outcomes.

Narrative therapy with an emotional approach for people with depression: Improved symptom and cognitive-emotional outcomes

ACCESSIBLE SUMMARY

Narrative therapy is a useful approach in the treatment of depression that allows that person to 're-author' his/her life stories by focusing on positive interpretations, and such focus on positive emotions is a crucial component of treatment for depression. This paper evaluates narrative therapy with an emotional approach (NTEA) as a therapeutic modality that could be used by nurses for persons with depression. A nurse-administered NTEA intervention for people with depression appears effective in increasing cognitive-emotional outcomes, such as hope, positive emotions and decreasing symptoms of depression. Thus, NTEA can be a useful nursing intervention strategy for people with depression.

ABSTRACT

Narrative therapy, which allows a person to 're-author' his/her life stories by focusing on positive interpretations, and emotion-focused therapy, which enables the person to realize his/her emotions, are useful approaches in the treatment of depression. Narrative therapy with an emotional approach (NTEA) aims to create new positive life narratives that focus on alternative stories instead of negative stories. The purpose of this study was to evaluate the effects of the NTEA programme on people with depression utilizing a quasi-experimental design. A total of 50 patients (experimental 24, control 26) participated in the study. The experimental group completed eight sessions of the NTEA programme. The effects of the programme were measured using a self-awareness scale, the Nowotny Hope Scale, the Positive Affect and Negative Affect Scale, and the Center for Epidemiological Studies-Depression Scale. The two groups were homogeneous. There were significant differences in hope, positive and negative emotions, and depression between the experimental and control group. The results established that NTEA can be a useful nursing intervention strategy for people with depression by focusing on positive experiences and by helping depressed patients develop a positive identity through authoring affirmative life stories.

Neural indicators of emotion regulation via acceptance vs reappraisal in remitted major depressive disorder

Mood disorders are characterized by impaired emotion regulation abilities, reflected in alterations in frontolimbic brain functioning during regulation. However, little is known about differences in brain function when comparing regulatory strategies. Reappraisal and emotional acceptance are effective in downregulating negative affect, and are components of effective depression psychotherapies. Investigating neural mechanisms of reappraisal vs emotional acceptance in remitted major depressive disorder (rMDD) may yield novel mechanistic insights into depression risk and prevention. Thirty-seven individuals (18 rMDD, 19 controls) were assessed during a functional magnetic resonance imaging task requiring reappraisal, emotional acceptance or no explicit regulation while viewing sad images. Lower negative affect was reported following reappraisal than acceptance, and was lower following acceptance than no explicit regulation. In controls, the acceptance > reappraisal contrast revealed greater activation in left insular cortex and right prefrontal gyrus, and less activation in several other prefrontal regions. Compared with controls, the rMDD group had greater paracingulate and right midfrontal gyrus (BA 8) activation during reappraisal relative to acceptance. Compared with reappraisal, acceptance is associated with activation in regions linked to somatic and emotion awareness, although this activation is associated with less reduction in negative affect. Additionally, a history of MDD moderated these effects.

Neural mechanisms of cognitive reappraisal in remitted major depressive disorder

BACKGROUND

Down-regulation of negative emotions by cognitive strategies relies on prefrontal cortical modulation of limbic brain regions, and impaired frontolimbic functioning during cognitive reappraisal has been observed in affective disorders. However, no study to date has examined cognitive reappraisal in unmedicated euthymic individuals with a history of major depressive disorder relative to symptom-matched controls. Given that a history of depression is a critical risk factor for future depressive episodes, investigating the neural mechanisms of emotion regulation in remitted major depressive disorder (rMDD) may yield novel insights into depression risk.

METHOD

We assessed 37 individuals (18 rMDD, 19 controls) with functional magnetic resonance imaging (fMRI) during a task requiring cognitive reappraisal of sad images.

RESULTS

Both groups demonstrated decreased self-reported negative affect after cognitive reappraisal and no group differences in the effects of cognitive reappraisal on mood were evident. Functional MRI results indicated greater paracingulate gyrus (rostral anterior cingulate cortex, Brodmann area 32) activation and decreased right midfrontal gyrus (Brodmann area 6) activation during the reappraisal of sad images.

LIMITATIONS

Trial-by-trial ratings of pre-regulation affect were not collected, limiting the interpretation of post-regulation negative affect scores.

CONCLUSIONS

Results suggest that activation of rostral anterior cingulate cortex, a region linked to the prediction of antidepressant treatment response, and of the right midfrontal gyrus, a region involved in cognitive control in the context of cognitive reappraisal, may represent endophenotypic markers of future depression risk. Future prospective studies will be needed to validate the predictive utility of these neural markers.

Social cognition in major depressive disorder: A new paradigm?

Social cognition refers to the brain mechanisms by which we process social information about other humans and ourselves. Alterations in interpersonal and social functioning are common in major depressive disorder, though only poorly addressed by current pharmacotherapies. Further standardized tests, such as depression ratings or neuropsychologic tests, used in routine practice provide very little information on social skills, schemas, attributions, stereotypes and judgments related to social interactions. In this article, we review recent literature on how healthy human brains process social decisions and how these processes are altered in major depressive disorder. We especially focus on interactive paradigms (e.g., game theory based tasks) that can reproduce daily life situations in laboratory settings. The evidences we review, together with the rich literature on the protective role of social networks in handling stress, have implications for developing more ecologically-valid biomarkers and interventions in order to optimize functional recovery in depressive disorders.