Mood Reactivity Research Articles

Reward dysfunction in major depression: Multimodal neuroimaging evidence for refining the melancholic phenotype

Reward dysfunction is thought to play a core role in the pathophysiology of major depressive disorder (MDD). Event-related potential (ERP) and functional magnetic resonance imaging (fMRI) studies have identified reward processing deficits in MDD, but these methods have yet to be applied together in a single MDD sample. We utilized multimodal neuroimaging evidence to examine reward dysfunction in MDD. Further, we explored how neurobiological reward dysfunction would map onto subtypes of MDD. The feedback negativity (FN), an ERP index of reward evaluation, was recorded in 34 unmedicated depressed individuals and 42 never-depressed controls during a laboratory gambling task. Ventral striatal (VS) activation to reward was recorded in a separate fMRI session, using an identical task, among a subgroup of 24 depressed individuals and a comparison group of 18 non-depressed controls. FN amplitude was blunted in MDD. This effect was driven by a MDD subgroup characterized by impaired mood reactivity to positive events, a core feature of melancholic MDD. A similar pattern was observed for VS activation, which was also blunted among the MDD subgroup with impaired mood reactivity. Neither FN amplitude nor VS activation was related to the full, DSM-defined melancholic or atypical MDD subtypes. Across the MDD sample, FN amplitude and VS activation were correlated, indicating convergence across methods. These results indicate that not all MDD is characterized by reward dysfunction, and that there is meaningful heterogeneity in reward processing within MDD. The current study offers neurobiological evidence that impaired mood reactivity is a key phenotypic distinction for subtyping MDD, and further suggests that the existing melancholic phenotype may require further refinement.

Clinical implications of loudness dependence of auditory evoked potentials in patients with atypical depression.

The loudness dependence of auditory evoked potentials (LDAEP) has been proposed as a useful biomarker of serotonin activity, and the LDAEP value is low in patients with melancholic depression. In this study, we evaluated LDAEP levels in patients with atypical depression. We recruited 53 patients with atypical depression and 68 patients with non-atypical depression. Subjects were evaluated by the Atypical Depression Diagnostic Scale (ADDS), Hamilton Rating Scale for Depression (HAMD), Hamilton Rating Scale for Anxiety (HAMA), Beck Scale for Suicidal Ideation (BSI), Behavioral Inhibition System and Behavioral Activation System (BIS/BAS) scales, and Hypomanic Personality Scale (HPS). To determine LDAEP, the peak-to-peak N1/P2 was measured at five stimulus intensities and the LDAEP was calculated as the linear-regression slope. Patients with atypical depression had stronger LDAEP values and higher BAS and HPS scores than those with non-atypical depression. LDAEP showed a pattern of gradual decrease according to ADDS score hierarchy in patients with major depressive disorder. In the atypical depression group, LDAEP showed significant negative correlation with the BSI score and significant positive correlation with BAS score. In the non-atypical depression group, LDAEP did not show any significant correlations with the scores of psychological scales. Our results suggest that there is a relatively deficient serotonergic activity in patients with atypical depression and that LDAEP reflects mood reactivity. The transient drop of serotonergic activity induced by mood vulnerability might contribute to suicidal tendencies in patients with atypical depression.

5-HTTLPR, HTR1A, and HTR2A cumulative genetic score interacts with mood reactivity to predict mood-congruent gaze bias.

Genetic variation within the serotonin system has been associated with biased attention for affective stimuli and, less consistently, with vulnerability for major depressive disorder. In particular, 5-HTTLPR, HTR1A (rs6295), and HTR2A (rs6311) polymorphisms have been linked with biased cognition. The present study developed a serotonergic cumulative genetic score (CGS) that quantified the number of risk alleles associated with these candidate polymorphisms to yield a single CGS. The CGS was then used to model genetic influence on the relationship between reactivity to a negative mood induction and negatively biased cognition. A passive-viewing eye-tracking task was administered to 170 healthy volunteers to assess sustained attention for positive, dysphoric, neutral, and threatening scenes. Participants were then induced into a sad mood and readministered the passive-viewing task. Change in gaze bias, as a function of reactivity to mood induction, was the primary measure of cognitive vulnerability. Results suggest that, although none of the individual genes interacted with mood reactivity to predict change in gaze bias, individuals with higher serotonin CGS were significantly more likely to look toward dysphoric images and away from positive images as mood reactivity increased. These findings suggest that a CGS approach may better capture genetic influences on cognitive vulnerability and reaffirm the need to examine multilocus approaches in genomic research.

Lamotrigine use in patients with binge eating and purging, significant affect dysregulation, and poor impulse control

Some patients with symptoms of binge eating and purging are successfully treated with specific serotonin reuptake inhibitors (SSRIs), but others experience only partial or no benefit. Significant affect dysregulation and poor impulse control may be characteristics that limit responsiveness. We report on the treatment of five patients with bulimia nervosa (BN), anorexia nervosa-binge/purge type (AN-B/P) or eating disorder not otherwise specified (EDNOS), using the anticonvulsant lamotrigine after inadequate response to SSRIs. Following addition of lamotrigine to an antidepressant in four cases, and switch from an antidepressant to lamotrigine in one case, patients experienced substantial improvement in mood reactivity and instability, impulsive drives and behaviors, and eating-disordered symptoms. These findings raise the possibility that lamotrigine, either as monotherapy or as an augmenting agent to antidepressants, may be useful in patients who binge eat and purge, and have significant affect dysregulation with poor impulse control.

Practitioner review: Dysphoria and its regulation in child and adolescent depression.

By emphasizing the importance of emotions, the 'affect revolution' in how human behavior is conceptualized has inspired a new generation of studies on dysphoric experience and its regulation in clinical depression, and novel efforts to characterize the precursors of affective disorders in juveniles at familial risk for depression. We review clinical, behavioral, and functional neuroimaging studies of dysphoric experience and its regulation in depressed children and adolescents, and in juvenile offspring of parents with histories of clinical depression. We discuss the implication of the literature in the context of maternal depression. Findings confirm the high rate of clinically significant dysphoria in depressed children and adolescents and reveal notable affective lability in daily life as a function of context and activity. Findings also show that depressed youngsters have problems in attenuating dysphoria. Similarly, never-depressed offspring at familial risk for depression display problems in mood repair and impaired mood repair mechanisms. Brain neuroimaging findings indicate that, overall, depressed, and high-risk youngsters differ from never depressed controls in neural functioning (activation, connectivity) both at rest and in response to emotion triggers. The evaluation of depressed youngsters should include questions about reactivity of dysphoric mood to the changing contexts of daily life and about how they manage (respond to) their own sadness and distress. The resultant information may help the clinician to restructure a young patient's day for the better and identify helpful mood repair responses. Evidence of impaired mood repair mechanisms in youngsters at high-risk for depression suggests the need for early intervention. But interventions must consider that many depressed and high-risk children have depressed mothers, who may be constrained in their ability to help offspring's emotion regulation efforts. To optimize treatment response of offspring, mothers of depressed children should therefore be routinely screened for depression and treated, as warranted.

Treatment Challenges of Atypical Depression: A Case Report

Symptoms such as mood reactivity, hyperphagia, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity are classified as atypical features of a major depressive episode. If these symptoms are concurrent with an episode of hypomania, the patient would be diagnosed with having a depressive episode in the continuum of bipolar II disorder. Because patients may have subsequent depressive episodes for years without any symptoms of hypomania, and because they can function unequivocally within the community due to the nature of the disorder, the diagnosis of a bipolar disorder often gets misclassified as one of a unipolar etiol ogy. Most evidence-based literature states the complexity of this diagnosis due to the subtlety of the presenting symptoms, and it is usually only with a thorough patient history that a clinician can diagnose a patient with bipolar II disorder when the chief complaint is atypical depression. An integrative approach to classifying the depression in terms of polarity requires the clinician to consider the longitudinal course of the patient’s illness; the tendency for depression to recur; the onset, prominence, and severity of depressive episodes; and whether there is a family history of bipolar disorder. It is essential to distinguish between unipolar and bipolar depression in order to treat current episodes and prevent further depressive episodes. The firstline treatment for unipolar depression with atypical features is monoamine oxidase inhibitors (MAOIs), whereas first-line treatment for bipolar depres sion is a mood stabilizer that may be augmented with an antidepressant. CASE

The validation of atypical depression among Chinese outpatients with depressive episodes in general hospital

Objective to evaluate the validation of among Chinese outpatients with depressive episodes and explore the role of atypical depressive symptoms in distinguishing bipolar depression from unipolar depression. Methods Structural clinical interviews with self-compiled questionnaires were performed on 276 outpatients with current depressive episode, then comparison of clinical characteristics including age of onset, gender proportion, seasonality, comorbidity of anxiety disorder, bipolar property, psychotic features, number of depressive episodes, and maximum duration of depressive episode were conducted between atypical (defined by DSM-Ⅳ-TR) and nonatypical depression. then the rate of atypical depressive symptoms were compared between unipolar depression and bipolar depression. Results The proportion of atypical depression among all the participants was 23.9%.Compared to nonatypical depression, psychotic features were more likely seen in atypical depression (20.0% vs 9.1%, P<0.05), but no difference was found in other clinical features between atypical and nonatypical depression. Except mood reactivity, atypical symptoms including oversleeping(45.5% vs 26.0%), overeating(22.7% vs 15.4%), weight gain(24.1% vs 14.6%), leaden paralysis(56.6% vs 47.2%), interpersonal rejection sensitivity(66.7% vs 34.2%) were more likely to occur in bipolar depression than in unipolar depression, the difference was statistically significant for oversleeping and interpersonal rejection sensitivity (P<0.05). Patients with mood reactivity differed little from those without mood reactivity in other clinical features. No association was found between mood reactivity, leaden paralysis and other criteria symptoms of atypical depression. Conclusion Atypical depression might be a useful concept, but its diagnostic criteria needs further validation among Chinese population. Key words: Atypical depression; Validation

Cognitive Therapy Skills Predict Cognitive Reactivity to Sad Mood Following Cognitive Therapy for Depression

Both patients' competence in the coping skills taught in Cognitive Therapy (CT) and patients' endorsement of dysfunctional cognitions following a sad mood induction (i.e., their cognitive reactivity) have been found to predict risk of relapse following a successful course of CT for depression. We examined the relationship between these constructs, specifically whether CT skills would be related to less cognitive reactivity following a mood induction among patients who responded to a course of CT. In a sample of 28 depressed patients, post-treatment CT skills were significantly related to less cognitive reactivity in response to a sad mood induction procedure (β = -.29). This relation was not accounted for by individual differences in mood reactivity. We discuss these findings as a key step in developing a more complete understanding of the role of CT coping skills and cognitive reactivity as markers of patients' vulnerability to relapse.

Sex moderates stress reactivity in heavy drinkers

Psychological stress and alcohol use disorders have a well-known connection. Individual differences in stress reactivity have been an area of interest in alcohol research, particularly given the relationship between craving and stress reactivity to later relapse. The present study examines the role of sex on stress-induced alcohol craving and emotional reactivity using a guided imagery stress paradigm. Participants were 64 non-treatment seeking heavy drinkers from the community who completed a two-session protocol that included two guided imagery exposures, Stress and Neutral. Participants reported their mood and craving before and after each exposure using the Differential Emotions Scale and the Alcohol Urge Questionnaire respectively. Analyses revealed a significant Stress×Sex×Trial effect on craving [F (1,61)=5.35; p<.05] after controlling for AUDIT scores [F (1,61)=8.16; p<.01] such that females reported greater increases in craving from baseline to post-imagery during the stress imagery versus the neutral imagery condition, than did males. Mood reactivity analysis showed similar patterns. Specifically, there was a significant Stress×Sex×Trial effect on the anxiety subscale of the DES [F (1,61)=15.81; p<.001] such that females reported greater increases in anxiety from baseline to post-imagery during the stress imagery versus the neutral conditions, than did males. These results suggest that female heavy drinkers were more sensitive to the effects of the stress-induction on alcohol craving and mood reactivity than males. If supported by future studies, these initial findings may help advance understanding of the mechanisms of stress and mood regulation as central to alcoholism liability and recovery in females.

Attentional disengagement predicts stress recovery in depression: An eye-tracking study.

Previous research has made significant progress elucidating the nature of cognitive biases in emotional disorders. However, less work has focused on the relation among cognitive biases and emotional responding in clinical samples. This study uses eye-tracking to examine difficulties disengaging attention from emotional material in depressed participants and to test its relation with mood reactivity and recovery during and after a stress induction. Participants diagnosed with Major Depressive Disorder (MDD) and never-disordered control participants (CTL) completed a novel eye-tracking paradigm in which participants had to disengage their attention from emotional material to attend to a neutral stimulus. Time to disengage attention was computed using a direct recording of eye movements. Participants then completed a stress induction and mood reactivity and recovery were assessed. MDD compared with CTL participants took significantly longer to disengage from depression-related stimuli (i.e., sad faces). Individual differences in disengagement predicted lower recovery from sad mood in response to the stress induction in the MDD group. These results suggest that difficulties in attentional disengagement may contribute to the sustained negative affect that characterizes depressive disorders.

Reducing children's social anxiety symptoms: Exploring a novel parent-administered cognitive bias modification training intervention

Social fears and worries in children are common and impairing. Yet, questions have been raised over the efficacy, suitability and accessibility of current frontline treatments. Here, we present data on the effectiveness of a novel parent-administered Cognitive Bias Modification of Interpretations (CBM-I) training tool. CBM-I capitalises on findings demonstrating an association between anxiety symptoms and biased interpretations, the tendency to interpret ambiguous situations negatively. Through CBM-I training, participants are exposed to benign resolutions, and reinforced for selecting these. In adults and adolescents, CBM-I training is effective at reducing symptoms and mood reactivity. In the present study, we developed a novel, child-appropriate form of CBM-I training, by presenting training materials within bedtime stories, read by a parent to the child across three consecutive evenings. Compared to a test-retest control group (n = 17), children receiving CBM-I (n = 19) reported greater endorsement of benign interpretations of ambiguous situations post-training (compared to pre-training). These participants (but not the test-retest control group) also showed a significant reduction in social anxiety symptoms. Pending replication and extensions to a clinical sample, these data may implicate a cost-effective, mechanism-driven and developmentally-appropriate resource for targeting social anxiety problems in children.

La dépression atypique : perspectives cliniques

This paper examines whether atypical depression is still a valid entity as a diagnosis subtype in the light of publications with most recent antidepressants. First, we present the origins of the diagnosis sub-specification of atypical depression, which is based on a different drug response to tricyclic antidepressants and mono amino oxydase inhibitors. Secondly, we discuss the different definitions that can be found for the terms of atypical depression. We present more specifically the definition of atypical depression as it is described in the DSM-IV, with its most important criterion: mood reactivity. Then we present a review of scientific publications questioning atypical depression validity as a clinical syndrome (based on medline researches). We will see whether this diagnosis is still relevant with the latest drugs used to treat mood disorders. A special focus is made on the link between atypical depression and bipolar disorder, based on Benazzi's work. Most of publications confirm that atypical depression is a valid syndrome regarding first antidepressants clinical trials. Nevertheless, more studies with the latest antidepressants and atypical antipsychotics are needed to confirm this hypothesis. The link between atypical depression and bipolar disorders seems to be quite strong although it requires further investigations. There are very few double-blind drug trials focusing on atypical depressions and results need to be confirmed by trials with new drugs. Moreover, we regret that there are no studies including cerebral imagery. More studies are also needed on neurobiology and psychotherapy specificity. Atypical depression is still a useful concept, because of its specific clinical presentation, evolution and treatments, even if more studies should be done. Atypical depression could also be useful to diagnose more easily some bipolar disorders and should help clinicians to focus more on suicidal risks and addiction evaluation for these patients, considering the mood reactivity and the link with bipolar disorder. To conclude, we propose that atypical depression should still figure in the future DSM-V for these different reasons.

Impulsivity and negative mood in adolescents with loss of control eating and ADHD symptoms: an experimental study

The aim of the study was to experimentally examine the reactivity of mood and impulsivity to negative mood induction in adolescents with loss of control (LOC) eating and adolescents with attention deficit hyperactivity disorder (ADHD) symptoms. The study included eighty-eight adolescents with LOC eating, ADHD symptoms, and control. Participants self-reported on mood and participated in a stop signal task before and after negative mood induction with Cyberball. Groups did not differ in impulsivity at baseline (p>.05). The LOC group presented with greater increase of negative mood than the ADHD group, and with greater increase of impulsivity than both other groups from pre- to post-Cyberball (p<.05). Stronger reactivity of negative mood and impulsivity in LOC eating corroborates findings in adults that the concepts' association might be specific to binge eating disorder. Additionally, findings add to previous results showing emotion regulation deficits in LOC eating. Future research should examine the concepts' impact on actual eating behavior including binge eating.

Attentional biases and the persistence of sad mood in major depressive disorder.

This study examined whether attentional biases for emotional information are associated with impaired mood recovery following a sad mood induction among individuals with and without major depressive disorder (MDD). Attentional biases were assessed with an exogenous cuing task using emotional facial expressions as cues among adults with (n = 48) and without (n = 224) current MDD. Mood reactivity and recovery were measured following a sad mood induction. Mood reactivity strongly predicted mood recovery; however, this relationship was moderated by attentional biases for negative emotional stimuli. Biases for sad and fear stimuli were associated with diminished mood recovery following mood induction across the sample. However, biases for sad stimuli were associated with significantly greater impairments in mood recovery among individuals with MDD than healthy controls. Furthermore, within the MDD group, impaired mood recovery was positively associated with depression severity. These results suggest that attentional biases maintain depression, in part, by facilitating the persistence of sad mood.

Untreated major depressive disorder with and without atypical features: A clinical comparative study

Aims and methodA comparative study of major depression with and without atypical features (as per DSM IV TR criteria) was planned to assess illness characteristics, resulting dysfunction and co-morbidities, which can have important implications in its management. Serially, 107 newly registered patients with depression not taking any treatment for at least a month were included. Patients with psychotic features in present or past, known bipolar disorder and likely organic aetiology were excluded. They were interviewed using SCID I (Structured clinical interview for DSM IV axis I disorders). Impulsiveness, suicidal ideation and functioning in various spheres was also assessed and compared between those with and without atypical features. ResultsAtypical features were seen in a significant number (55.14%) of patients especially from urban and semi-urban areas. Interpersonal sensitivity and leaden paralysis were the commonest atypical features apart from mood reactivity. Presence of hypersomnia and/or hyperphagia documented in 36 (33.65%) of 107 patients. Comparison of patients with and without atypical features revealed no significant difference in illness characteristics including suicidal ideation. However, they differed in level of impulsiveness and associated psychiatric co-morbidities. Also, deterioration of functioning with rising HDRS was more significant in patients without atypical features. Clinical implicationsPresence of atypical features is common in patients with major depressive disorder. These patients should be vigilantly assessed and managed in view of equal morbidity but different co-morbidities like anxiety and soft bipolar disorders than those without atypical features.

Mood reactivity rather than cognitive reactivity is predictive of depressive relapse: A randomized study with 5.5-year follow-up.

The current study examined whether cognitive reactivity, cognitive extremity reactivity, and mood reactivity following mood provocation predicted relapse in depression over 5.5 years. Additionally, this study was the 1st to examine whether changes in cognitive reactivity and mood reactivity following preventive cognitive therapy (PCT) mediated the preventive effect of PCT on relapse. One hundred eighty-seven remitted recurrently depressed outpatients were randomized over treatment as usual (TAU) versus TAU + PCT with 5.5-year follow-up. Relapse in depression was assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (Spitzer, Williams, Gibbon, & First, 1990). Mood reactivity predicted time to relapse over 5.5 years. We found no evidence that cognitive reactivity was a risk factor for relapse in depression. Moreover, unprimed dysfunctional beliefs predicted relapse directly. There was no indication of mediation by changes in cognitive reactivity (including extremity of the beliefs and unprimed beliefs) or mood reactivity on the preventive effect of PCT. Further, explorative analyses revealed that increases in cognitive and mood reactivity over time also predicted time to relapse. Our findings highlight a need to focus on mood reactivity instead of beliefs as a risk factor for relapse in depression. Similar to a previous study, we found no indications that cognitive therapy after remission reduced dysfunctional beliefs, cognitive reactivity, or extremity. Future studies should examine cognitive reactivity and mood reactivity in daily life as predictors of relapse.

1824 – Menstrually related cyclothymia: a case report

Introduction Premenstrual dysphoric disorder is a premenstrual syndrome comprising physical and psychic symptoms. Bipolar disorders, particularly “soft” forms, share symptoms such as depressive mood, irritability or mood reactivity with premenstrual dysphoric disorder, posing challenges on differential diagnosis. In the present work a case of a woman suffering from cyclothymia is reported, with mood episodes confined in the luteal phase of the menstrual cycle. Methods Case Report. Results A 42-year-old married Caucasian woman is presented, suffering from mood disorder episodes lasting for 10-12 days each, during the luteal phase of the menstrual cycle, and remitting after the beginning of her menses. The mood episodes occurred since the age of 20, in almost every menstrual cycle. The patient described hypomanic symptoms during the first 4-5 days of the luteal phase, reporting irritable mood, pressured speech, increased libido as well as vividness of her perceptions and excessive goal-directed activity. The hypomanic symptoms were followed by irritable and depressive mood, fatigue, hypersomnia, tearfulness, decreased self-esteem and pessimism, lasting for another 6-7 days. The patient also reported migraine and binge-eating episodes during each depressive phase. A full range of examinations, including blood and hormonal tests, yielded normal results. Lamotrigine was titrated at 200 mg/day, with subsequent amelioration of symptoms. Conclusions The exact relationship between premenstrual dysphoric disorder and other disturbances, which either coexist, or deteriorate premenstrually, or even synchronize with the menstrual cycle, has not been elucidated yet. Studies aiming at a better understanding of this relationship could aid at accurate diagnosis and treatment.

Here we go again: Anticipatory and reactive mood responses to recurring unpleasant situations throughout adulthood.

Much is known about reactive mood changes due to unpleasant tasks or situations. This research provides evidence that recurring events may also elicit anticipatory mood changes, and that both reactive and anticipatory mood responses need to be considered when studying affective experiences and emotion regulation. Based on prevalent theories on emotion regulation, we propose that anticipatory and reactive mood responses to recurring unpleasant events may change throughout adulthood, reflecting an age-related shift in emotion-regulation priorities. An unpleasant (monotonous) face-rating task across 10 100-min sessions was completed by 154 participants aged 20 to 81 years. Positive mood was assessed before and after each session. Almost all participants experienced a decline in positive mood while working on the task. However, in contrast to younger adults who showed a rapid drop in pretask mood in line with previous experience, older adults maintained their positive pretask mood across several sessions, suggesting a shift from anticipatory mood adjustment to positive mood maintenance with advancing adult age.

Supplemental Material for Mood Reactivity Rather Than Cognitive Reactivity Is Predictive of Depressive Relapse: A Randomized Study With 5.5-Year Follow-Up

Supplemental Material for Mood Reactivity Rather Than Cognitive Reactivity Is Predictive of Depressive Relapse: A Randomized Study With 5.5-Year Follow-Up

Supplemental Material for Here We Go Again: Anticipatory and Reactive Mood Responses to Recurring Unpleasant Situations Throughout Adulthood

Supplemental Material for Here We Go Again: Anticipatory and Reactive Mood Responses to Recurring Unpleasant Situations Throughout Adulthood