More excited for negative facial expressions in depression: Evidence from an event-related potential study

Objective

This study aims to investigate the intensity evaluation of social stimuli in depression.

Methods

Twenty-four never-disordered control participants (NC), 24 sub-clinically depressed individuals and 24 participants diagnosed with a current major depressive disorder (MDD) were recruited. All participants completed an emotional intensity evaluation task, in which they were required to judge the intensity of the facial expressions by pressing response keys, with the event-related potential (ERP) being recorded during the process.

Results

The MDD participants had higher intensity scores for sad faces compared with the NC group, longer reaction times (RTs) for all faces compared with other groups and higher P1 and P2 amplitude for sad faces compared with other faces. The sub-clinically depressed individuals had lower intensity scores for happy and neutral faces compared with other groups, longer RTs for happy faces compared with other faces and higher P1 and P2 amplitudes for happy faces compared with sad faces.

Conclusion

The findings suggest that the MDD participants are more excited for negative facial expressions, while the sub-clinically depressed individuals might have a disturbed perception for happy stimuli, which suggests a different cognitive pattern for facial expressions between MDD and sub-clinical depression. Moreover, the deep perception for sad faces is correlated with increased suicidal ideation.

Significance

The intensity effect of social stimuli (facial expressions) was observed in sub-clinically and clinically depressed (MDD) individuals simultaneously, which might suggest that the more excited perception for negative facial expressions is a stable cognitive vulnerability possibly associated with the occurrence or recurrence of depression.     

Deficient inhibition of return for emotional faces in depression

Depression is a commonly-occurred mental disorder. Researchers have highlighted the attentional bias of depressive disorders, although results have been mixed. The cue-target task has often been used to explore attentional bias; a particular phenomenon revealed by such studies is the inhibition of return (IOR). However, cue-target task has seldom been used so far in the study of depressed patients. The aim of the present study was to investigate the IOR phenomenon in depressed individuals in cue-target task using emotional faces as cues.Control participants who had never suffered depression (NC), participants who had experienced at least two depressive episodes in their lives but were currently remitted (RMD), and participants diagnosed with a current major depressive disorder (MDD), were recruited using BDI, BAI, HDRS and DSM-IV as tools. Seventeen participants in each group completed a cue-target task in a behavioral experiment that comprised three kinds of experimental condition, two cue types and four face types. Each participant also completed a simpler cue-target task in an event-related potential (ERP) experiment. In cue-target task, a target appeared after a cue and the participant responded to its location.In the behavioral experiment, it was found that when the stimulus onset asynchrony (SOA) was 14 ms, the NC and RMD participants had IOR effects for all faces and MDD participants for angry and sad faces. When the SOA was 250 ms, all three groups all had cue validity for sad faces but the effect was much more marked for the MDD group. When the SOA was 750 ms, the NC participants had an IOR effect for sad faces, the RMD participants had cue validity for angry, happy and sad faces, and the MDD participants had cue validity for sad faces and an IOR effect for angry faces. In the ERP experiment, the NC participants showed bigger P3 amplitude for happy cue compared with the other groups, smaller P1 amplitude for happy faces in the invalid cue condition than for other faces, smaller P1 amplitude for sad faces in the valid cue condition than for happy faces, bigger P3 amplitude for happy faces in the valid cue condition compared with MDD participants, and bigger P3 amplitude for sad faces in the invalid cue condition compared with other groups. The RMD participants had larger P3 amplitude for sad cue than for other faces, larger P3 amplitude for happy faces in the valid cue condition compared with MDD participants, and smaller P3 amplitude for sad faces in the invalid cue condition compared with NC participants. The MDD participants had larger P1 amplitude for sad cue compared with other groups, larger P3 amplitude for sad cue than for other face cues, smaller P3 amplitude for sad faces in the invalid cue condition compared with NC participants, and smaller P3 amplitude for happy faces in the valid cue condition compared with other groups.It can be concluded that the MDD participants had cue validity and deficient IOR for negative stimuli. The deficient inhibition of negative stimuli renders them unable to eliminate the interference of negative stimuli and causes the maintenance and development of depression. The RMD participants had cue validity and deficient IOR for both positive and negative stimuli, which enables them to perceive positive and negative stimuli sufficiently and to maintain emotional balance.     

Neural correlates of inhibitory deficits in depression

The present study used functional magnetic resonance imaging to examine neural correlates of inhibitory dysfunction in individuals diagnosed with major depressive disorder (MDD). Twelve MDD participants and 12 never-depressed controls completed the negative affective priming (NAP) task in the scanner. Results indicated that, in depressed participants, increased activation in the rostral anterior cingulate cortex (rACC) is associated with inhibition of negative, but not positive, words; in contrast, in nondepressed participants, inhibition of positive, but not negative, words is associated with increased activation in the rACC. These findings indicate that abnormalities in neural function, especially in the rACC, may underlie difficulties experienced by depressed individuals in inhibiting negative thoughts. These results underscore the importance of continuing to examine the relation between cognitive and neural functioning in depression in order to gain a broader and more integrative understanding of this disorder.     

Reduced electrocortical response to threatening faces in major depressive disorder

Background: There is growing support for the emotion context insensitivity hypothesis, which states that major depressive disorder (MDD) is associated with a deficit in emotional reactivity. Under this hypothesis, depressed individuals exhibit reduced behavioral and physiological responses to both appetitive and aversive stimuli. We sought to examine this possibility using the late positive potential, a neural response sensitive to aversive and threatening stimuli. Methods: Forty‐seven individuals participated in the study, 22 of whom met criteria for current MDD and 25 with no history of depression or other Axis I disorders. All individuals passively viewed emotional faces while event‐related potentials were recorded. Results: The vertex positive potential was significantly increased in response to fearful and angry faces across the entire sample. The late positive potential was also increased in response to threatening faces, but only among never‐depressed individuals. In the MDD group, this electrocortical response to emotional faces was absent. Conclusions: This study provides neural evidence in support of the view that MDD is associated with blunted emotional reactivity to negative stimuli, which until now has been examined primarily with measures of behavior, self‐report, and peripheral physiology. These results are also consistent with two prior studies showing reduced amygdala activation in response to fearful faces among depressed individuals. It remains to be determined whether abnormal activity in response to emotional stimuli is associated with trait risk for MDD or results from MDD. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

The neural substrates of affective processing toward positive and negative affective pictures in patients with major depressive disorder

Previous studies examining neural responses to emotional stimuli in individuals with major depressive disorder (MDD) have indicated increased responses within the left amygdala to sad faces, and increased activity within the visual cortex and striatum to expressions of happiness. Using functional magnetic resonance imaging (fMRI), the current study measured neural responses to neutral, positive and negative pictures of the International Affective Picture System in 15 healthy individuals and 15 patients with MDD. Depressed individuals demonstrated lower activity in the right hippocampus and the right insula to negative affective pictures, whereas they showed lower activity in the right anterior cingulate cortex and the left insula to positive pictures. However, within the MDD group, the severity of depression correlated with the activity of the left amygdala, bilateral inferior orbitofrontal areas, and the left insula to negative pictures, whereas there were no clear indications of association between specific cerebral regions and positive pictures. Our findings indicate that preferential decreases in the left amygdala in response to negative pictures might be involved in the processing of emotional stimuli in depressed individuals. Also, these findings suggest that the bilateral inferior orbitofrontal cortices and left amygdala may be preferentially recruited in MDD patients, but not in healthy individuals.     

Never-depressed females with a family history of depression demonstrate affective bias

According to cognitive theories of depression, individuals susceptible to depression attend selectively to negative information. The purpose of the study was to examine if such an affective processing bias is present in never-depressed individuals with a family history of major depressive disorder (MDD). Formerly depressed female patients having at least one first-degree relative with a history of MDD (n=23), their never-depressed female siblings (n=21) and never-depressed female controls (n=21) performed a conventional and an emotional Stroop task using negative, positive and neutral words. A significant effect was found of group on negative processing bias; post hoc comparisons indicated that never-depressed siblings showed a larger negative processing bias than never-depressed controls. No significant differences were observed in positive bias or conventional interference between the three groups. Our findings suggest that never-depressed females with a family history of depression, like depressed patients, have more difficulties to inhibit negative material and to direct their attention towards task-specific material. This adds to the existing evidence that affective processing bias is a trait characteristic that contributes to the onset of depression and that could be a useful endophenotype for MDD.     

Affective disorders and cognitive failures: a comparison of seasonal and nonseasonal depression

Seasonal depression shares certain common symptoms with nonseasonal depression; however, the two disorders have never been examined in a single study, to the authors' knowledge. The goal of this research was to examine the potential similarities in cognitive impairments in seasonal affective disorder and major depressive disorder in college students in the Midwest. Identification of affective disorders was based on participants' self-reported behavior and affect on the Beck Depression Inventory and the Seasonal Pattern Assessment Questionnaire. A group of 93 participants was assessed for major depressive disorder and seasonal affective disorder in late autumn and completed the Cognitive Failures Questionnaire for reported difficulties in everyday activities that correspond to problems with perception, attention, and memory retrieval. The results indicated that seasonal affective disorder was highly prevalent (28.0%), substantially more so than major depressive disorder (8.6%). Similar to previous research on major depressive disorder, gender differences were also evident among participants with seasonal affective disorder, with more women qualifying than men. Both affective disorders were associated with higher reports of cognitive failures in comparison to participants with no depressive symptoms. These results reveal that individuals with seasonal affective disorder showed cognitive impairments similar to those with nonseasonal depression.     

Examining the relationship between lateralisation for processing emotional faces,depression, and sex

It is now relatively well established that the right hemisphere is specialised for processing facial emotion; however, there is variability in this pattern of lateralisation. One factor that has been examined is atypical lateralisation in individuals diagnosed with clinical psychological conditions. To date the evidence regarding the neuropsychological processing of emotional stimuli in individuals with depression is contradictory. In this study 160 participants completed the Beck Depression Inventory and the chimeric faces test, a test of lateralisation for the processing of facial expressions of each of the six basic emotions. A negative relationship between depression and lateralisation was found for females only, showing that women with higher depression scores tend to be less strongly lateralised to the right hemisphere, or even lateralised to the left hemisphere, for processing facial emotion. The strength of this relationship also varied across the different emotions with the clearest results for the processing of anger, disgust, and fear. There were no significant findings for males. The possible reasons for there being a sex difference in our findings and an attempt to reconcile the disparate findings within this area of research are discussed.     

Early life trauma and directional brain connectivity within major depression

Objective: Early life trauma (ELT) is a significant risk factor for the onset of depression. Emerging findings indicate ELT is associated with enhanced amygdala reactivity to aversive stimuli in never‐depressed healthy controls as well as those with acute depression but may be absent in non‐ELT exposed depressed. The precise mechanism mediating these differences in amygdala reactivity remains unclear. Method: The authors used Granger causality methods to evaluate task‐based directional connectivity between medial or lateral prefrontal cortex (PFC) and amygdala in 20 unmedicated patients with current major depressive disorder (MDD) and 19 healthy matched controls while participants engaged in an affective variant of the flanker task comparing response to sad and neutral faces. These data were correlated with childhood trauma history. Results: Exposure to ELT was associated with failure of inhibition within the MDD group based on medial PFC–amygdala connectivity. In contrast, non‐ELT exposed MDD was associated with a negative causal pathway from medial prefrontal cortex to amygdala, despite reduced dorsolateral PFC input in comparison to healthy controls. Neither MDD group demonstrated significant lateral PFC–amygdala connectivity in comparison to healthy controls. Conclusions: Failure of the circuit implicated in emotion regulation was associated with a significant history of ELT but not with MDD more broadly. Non‐ELT related depression was associated with intact regulation of emotion despite the absence of difference in severity of illness. These findings indicate opposing system‐level differences within depression relative to ELT are expressed as differential amygdala reactivity. Hum Brain Mapp 35:4815–4826, 2014. © 2014 Wiley Periodicals, Inc .     

Initial investigation of behavioral activation therapy for co-morbid major depressive disorder and obesity

More than one-third of treatment-seeking obese patients are clinically depressed. No evidence-based treatments exist for individuals with comorbid depression and obesity. Behavioral activation (BA), an effective treatment for depression, might also facilitate weight loss. The objective of this study is to evaluate the feasibility and efficacy of BA plus nutrition counseling for weight loss among individuals with comorbid major depressive disorder (MDD) and obesity. The BA intervention targeted both weight reduction and depression in 14 obese patients (79% female; 86% Caucasian) who met criteria for MDD. At baseline, mean Beck Depression Inventory (BDI-II) score was 26.71, and mean Hamilton Depression Rating Scale (HDRS) score was 16.00. Significant reductions at 12-weeks in both BDI-II and HDRS were observed with 10 participants reaching full remission at post treatment. Reductions in body weight, daily caloric intake, and physical activity were observed. BA with nutrition counseling appears to have potential as a weight loss treatment in the context of depression. Results support the need for a randomized controlled trial to evaluate the efficacy of BA for both weight loss and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Pupillary and reaction time measures of sustained processing of negative information in depression.

BACKGROUND: Disruptions of emotional information processing (i.e., attention to, memory for, and interpretation of emotional information) have been implicated in the onset and maintenance of depression. The research presented here investigated cognitive and psychophysiological features of a particularly promising correlate of depression: sustained processing of negative information 4--5 sec after an emotional stimulus. METHODS: Pupil dilation data and reaction times were collected from 24 unmedicated depressed and 25 nondepressed adults in response to emotional processing tasks (lexical decision and valence identification) that employed idiosyncratically generated personally relevant and normed stimuli. Pupil dilation was used to index sustained cognitive processing devoted to stimuli. RESULTS: Consistent with predictions, depressed individuals were especially slow to name the emotionality of positive information, and displayed greater sustained processing (pupil dilation) than nondepressed individuals when their attention was directed toward emotional aspects of information. Contrary to predictions, depressed participants did not dilate more to negative than positive stimuli, compared to nondepressed participants. CONCLUSIONS: These data suggest depressed individuals may not initially attend to emotional aspects of information but may continue to process them seconds after they have reacted to the information.     

The association between depressive symptoms and emotion recognition is moderated by emotion regulation

In this study, we examined the associations between depression and aspects of emotional functioning, namely emotion recognition, affectivity and interpersonal problems. Particularly, the moderating role of emotion regulation in these interrelations was tested in a sample of 85 women, who exhibited a wide range of depressive symptoms (Composite International Diagnostic Interview (CIDI), Beck Depression Inventory (BDI)). Emotion recognition was assessed with a paradigm displaying a widely used set of photographs of the six basic emotions in graded intensities. Further, participants were examined regarding emotion regulation (Emotion Regulation Questionnaire (ERQ)), interpersonal problems (Inventory of Interpersonal Problems-Circumplex (IIP-C)) and affectivity (Affect Intensity Measure (AIM), Positive and Negative Affect Schedule (PANAS)). Besides correlation analyses, Johnson–Neyman technique for probing interactions in linear regression models was applied to test for possible moderating effects. Depressive symptoms were positively correlated with error rates in anger recognition, but not with the other basic emotions. This association was moderated by suppression in that regard that more severely depressed women who more frequently used suppression showed superior recognition of angry faces than those with lower suppression values. Further, suppression was associated with an affective imbalance and interpersonal problems in women with current depressive disorder. In sum, our results emphasize the importance of differentiating subtypes of depression depending on emotion regulation capabilities for research on or treatment of emotional functioning in depression.     

Decreased cognitive control in response to negative information in patients with remitted depression: an event-related potential study

Background

Major depressive disorder (MDD) is associated with difficulty disengaging attention from emotionally negative information. Few studies have investigated whether euthymic individuals with a history of depression (remitted MDD [rMDD]) show similar deficits, and little is known about concomitant neurophysiological features of such deficits. To fill these gaps, we investigated cognitive control over emotional stimuli in participants with rMDD and controls without history of depression or psychopathology.

Methods

We collected 128-channel event-related potentials (ERPs) while participants performed a cued emotional conflict task. During the task, a cue instructed the participant to respond to the actual or opposite valence of an upcoming happy or sad face.

Results

We enrolled 15 individuals with rMDD and 18 controls in our study. Event-related potentials showed no group differences in response to the cues, highlighting preserved preparatory processes when anticipating an emotional conflict. However, relative to the control group, the rMDD group responded more slowly and showed reduced N450 amplitudes on trials that required disengaging from negative faces (pressing “happy” in response to a sad face).

Limitations

The sample size was small, and the null finding in the cue-locked N2 analyses may be owing to low power.

Conclusion

Our results suggest a selective deficit in cognitive control over sad stimuli in individuals with rMDD. Additional studies will be required to pinpoint whether the current findings stem from impairments in response conflict, conflict monitoring and/or attentional disengagement in response to sad stimuli. Moreover, future studies are warranted to evaluate whether decreased cognitive control in response to negative information might increase the risk for future depressive episodes.     

Automatic Processing of Emotional Faces in High-Functioning Pervasive Developmental Disorders: An Affective Priming Study

This study examined automatic processing of emotional faces in individuals with high-functioning Pervasive Developmental Disorders (HFPDD) using an affective priming paradigm. Sixteen participants (HFPDD and matched controls) were presented with happy faces, fearful faces or objects in both subliminal and supraliminal exposure conditions, followed by Japanese ideographs for which the participants provided liking ratings. In the HFPDD group, affective priming was not found in either condition; the control group showed affective priming for both emotional faces under the subliminal condition and only for happy faces under the supraliminal condition. Results suggest that the social deficit in autism may derive in part from a failure in evaluating the emotional significance of emotional faces, a function for which the amygdala plays an important role.     

Cognitively preserved MS patients demonstrate functional differences in processing neutral and emotional faces

The ability to recognize emotional facial expressions is crucial to adequate social behavior. Previous studies have suggested deficits in emotion recognition in multiple sclerosis (MS). These deficits were accompanied by several confounders including cognitive or visual impairments, disease duration, and depression. In our study we used functional MRI (fMRI) to test for potential early adaptive changes in only mildly disabled MS patients performing an emotion recognition task including the facial expressions of the emotions anger, fear and disgust. Fifteen relapsing-remitting MS patients with a median Expanded Disability Status Scale (EDSS) score of 2 (range: 0-3.5) and 15 healthy controls (HC) matched for age, gender, and education underwent behavioral (BERT: behavioral emotion recognition test; BRB-N: Brief Repeatable Battery for neuropsychological tests, WCST: Wisconsin Card Sorting Test) and clinical assessments (BDI: Beck Depression Inventory). Conventional MRI at 3.0T served to assess whole-brain volume, white matter, gray matter, cerebrospinal fluid, and T2-lesion load; during fMRI, participants were confronted with neutral, scrambled, angry, disgusted, and fearful faces, and houses. In the absence of differences in cognitive performance and in the ability to accurately recognize distinct emotional facial expressions, MS patients demonstrated excess fMRI activations during facial recognition compared to HC. These differences concerned the posterior cingulate cortex (PCC) and precuneus for anger and disgust contrasted to neutral faces, and the occipital fusiform gyri and the anterior CC for neutral faces versus houses. This study provides first evidence for excess activation during processing of higher order visual stimuli of emotional content in the absence of emotional, visual or cognitive behavior abnormalities already in earlier stages of MS.     

Prefrontal cortical response to emotional faces in individuals with major depressive disorder in remission

Abnormalities in the response of the orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex (DLPFC) to negative emotional stimuli have been reported in acutely depressed patients. However, there is a paucity of studies conducted in unmedicated individuals with major depressive disorder in remission (rMDD) to assess whether these are trait abnormalities. To address this issue, 19 medication-free rMDD individuals and 20 healthy comparison (HC) participants were scanned using functional magnetic resonance imaging while performing an implicit emotion processing task in which they labeled the gender of faces depicting negative (fearful), positive (happy) and neutral facial expressions. The rMDD and HC groups were compared using a region-of-interest approach for two contrasts: fear vs. neutral and happy vs. neutral. Relative to HC, rMDD showed reduced activation in left OFC and DLPFC to fearful (vs. neutral) faces. Right DLPFC activation to fearful (vs. neutral) faces in the rMDD group showed a significant positive correlation with duration of euthymia. The findings support deficits in left OFC and DLPFC responses to negative emotional stimuli during euthymic periods of MDD, which may reflect trait markers of the illness or a 'scar' due to previous depression. Recovery may also be associated with compensatory increases in right DLPFC functioning.     

The role of sexual abuse on functional neuroimaging markers associated with major depressive disorder

Objectives. Victims of child sexual abuse can develop depression and other mental health conditions that follow them well into adulthood. This study aimed to clarify the role of sexual abuse (SA) on functional imaging markers associated with MDD. Methods. Thirty-seven patients with MDD only; and 13 patients with both MDD and SA and 43 healthy controls performed emotional attention shifting tasks during fMRI session. Clinical diagnoses were made by consultant psychiatrists based on the DSM-IV-TR criteria and diagnoses were confirmed using SCID-I. Magnetic resonance images were obtained with a Philips Achieva 3 Tesla MRI scanner. Short form childhood trauma questionnaire, Hamilton Rating Scale for Depression and Beck's Depression Inventory were also employed. Data were analysed with Statistical Parametric Mapping 8 (SPM8). Results. Using the contrast judgment of emotion minus judgment of geometry following emotional neutral stimuli, patients with MDD showed significantly reduced activation in comparison to healthy controls in the area of the right fusiform gyrus. With the contrast judgment of emotion minus judgment of geometry following emotional negative stimuli, participants with MDD and SA showed significantly higher activation in the area of the left inferior parietal lobe in comparison to participants with MDD without SA. Conclusions. The history of sexual abuse affects functional neuroimaging markers associated with major depressive disorder.     

The prevalence of emotional and cognitive dysfunction in a general medical population: using the MMSE, GHQ, and BDI

The Mini Mental Status Examination, General Health Questionnaire-30, and Beck Depression Inventory were administered to 335 randomly selected hospitalized medical patients. Twenty-eight percent of the population had evidence of cognitive dysfunction on the Mini Mental Status Examination, 61% showed emotional dysfunction on the General Health Questionnaire-30, and 36% were depressed as measured by the Beck Depression Inventory. Only 29% of the patients had no evidence of emotional or cognitive dysfunction. Medical resident diagnostic concordance with these tests was poor. The effects of demographic variables on these test scores were also determined.     

Identifying differences in biased affective information processing in major depression

This study investigates the extent to which participants with major depression differ from healthy comparison participants in the irregularities in affective information processing, characterized by deficits in facial expression recognition, intensity categorization, and reaction time to identifying emotionally salient and neutral information. Data on diagnoses, symptom severity, and affective information processing using a facial recognition task were collected from 66 participants, male and female between ages 18 and 54 years, grouped by major depressive disorder (N = 37) or healthy non-psychiatric (N = 29) status. Findings from MANCOVAs revealed that major depression was associated with a significantly longer reaction time to sad facial expressions compared with healthy status. Also, depressed participants demonstrated a negative bias towards interpreting neutral facial expressions as sad significantly more often than healthy participants. In turn, healthy participants interpreted neutral faces as happy significantly more often than depressed participants. No group differences were observed for facial expression recognition and intensity categorization. The observed effects suggest that depression has significant effects on the perception of the intensity of negative affective stimuli, delayed speed of processing sad affective information, and biases towards interpreting neutral faces as sad.     

Childhood emotional trauma and chronic posttraumatic stress disorder in adult outpatients with treatment-resistant depression

The intent of this study was to test the hypothesis that patients with treatment-resistant depression are more likely than treatment responsive patients to suffer from sequelae of childhood trauma that may perpetuate depression despite adequate medication treatment. Twenty participants with treatment-resistant depression and 20 participants with treatment-responsive depression were administered a structured interview and a battery of psychological tests to assess levels of current depression, confirm diagnosis, and quantify childhood trauma and presence of dissociative phenomena. Tests used include the Beck Depression Inventory, the Mini International Neuropsychiatric Interview, the Minnesota Multiphasic Personality Inventory-2, the Childhood Trauma Questionnaire, and the Trauma Symptom Inventory. Compared with treatment responders, the treatment-resistant participants were significantly more depressed, had significantly more comorbid anxiety disorders, reported significantly greater levels of childhood emotional abuse, and experienced current-day sequelae of childhood emotional abuse. The hypothesis was partially supported by these results. This study suggests that reported history of childhood emotional abuse and sequelae of that abuse may be associated with treatment resistance in depressed outpatients.