Neurobiology of Decision Making in Depressed Adolescents: A Functional Magnetic Resonance Imaging Study

Abstract

Objective Despite evidence that impaired reward- and risk-related behavior during adolescence can have potentially serious short- and long-term consequences, few studies have investigated the impact of depression on reward-related selection in adolescents. This study examined the relationship between reward-related behavior and prefrontal activations in depressed and healthy adolescents during a decision-making task. Method Twenty-two adolescents with no personal or family history of psychiatric illness and 22 adolescents with major depressive disorder were administered a monetary two-option decision-making task, the Wheel of Fortune, using a functional magnetic resonance imaging protocol. The analysis was focused on the selection phase, i.e., the first phase of the decision-making process, which typically includes two more phases, the anticipation of outcome and the feedback. Results Similar prefrontal regions were activated in healthy and depressed adolescents during reward-related selection. However, in a contrast involving the selection of high-risk (low-probability/high-magnitude reward) vs. equal-risk (50% chance of reward) options, healthy adolescents showed greater activation than patients in the right lateral orbitofrontal cortex (OFC), whereas participants with depression showed greater activation than healthy subjects in the left dorsal OFC and right caudal anterior cingulate cortex. In addition, healthy adolescents, but not participants with depression, showed a negative correlation between high-risk behavior and neuronal activation in pre-specified prefrontal regions. Conclusions These results suggest subtle changes in the neural responses to reward selection in depressed adolescents. In addition to the replication of these findings in larger samples, the association of these neuronal changes with treatment response and prognosis should be examined.

Current Neural and Behavioral Dimensional Constructs Across Mood Disorders

“…Reward system abnormalities have also been found both in adult (81) and adolescent populations with MDD (82), leading to a characterization of “ hypo-sensitivity to rewards ” in MDD, with hypo-activation in VS/PVC (83, 84). In fact, a recent study with adolescents with MDD found reduced reward-related activity in the right caudal ACC, caudate, and OFC during high risk-high gain trials (85). Similarly, (82) found decreased activation in the caudate and inferior OFC during both reward anticipation and response in 9–17 years old with MDD.…”

Decision-Making in Diabetes Mellitus Type 1

“…and reward. 68 Reward-related decision-making was examined within a longitudinal study of 221 11-yearold boys, 25 of whom had a depressive disorder at age 10 or 11. 69 Participants completed a behavioral decisionmaking task called the reward-contingent decision (RCD) paradigm 70,71 (see Table 2) which involves reward-related decisions under conditions of uncertainty and is considered to be emotional in nature.…”

“…After high-magnitude rewards, those with depression exhibited a greater response than control participants in the amygdala bilaterally and the inferior OFC. 76 In another neuroimaging study using fMRI, 68 22 adolescents with no personal or family history of psychiatric illness and 22 adolescents with MDD were administered a two-choice decision-making task involving probabilistic monetary rewards with varying levels of risk: the Wheel of Fortune. 77 During risky decision-making, healthy adolescents used the brain regions involved in inhibitory control (right lateral OFC), whereas depressed adolescents engaged areas involved in conflict monitoring (right caudal ACC).…”

“…The authors hypothesized that reduced inhibitory control, as reflected by reduced activation of the right lateral OFC in depressed adolescents, may provide a neurobiological explanation for impulsivity (e.g., suicidal behavior and substance abuse among depressed youth). 68 Because patients with type 1 DM exhibit an increased prevalence of depressive symptoms, and, as decisionmaking is impaired in patients with major depressive disorder (MDD), the "somatic marker hypothesis" 46 may be especially relevant in conceptualizing decisionmaking in patients with type 1 DM and comorbid MDD. Mayberg has proposed a working model of depression, implicating failure of the coordinated interactions of Wheel of Fortune Two-choice task with probabilistic monetary outcomes Separately targets reward and punishment processing a distributed network of limbic-cortical pathways.…”

Altered neural function to happy faces in adolescents with and at risk for depression

“…To date, neuroimaging studies of adolescent MDD have examined reward processing in the context of monetary reward. These studies have predominantly reported diminished striatal response during the anticipation and receipt of reward in adolescents with MDD (Forbes et al, 2010; Olino et al, 2011; Shad et al, 2011). Given that emotional facial expressions are socially relevant stimuli and that positive (i.e., happy) emotional facial expressions are perceived as cues of potential social reward in adolescents, it is therefore possible that happy face stimuli would be associated with alterations in neural systems supporting social-affective processing and the regulation of social-affective processes, in adolescents with mood disorders.…”