The Conflict of Reward in Depression

In Love and Death, Woody Allen wrote: “To love is to suffer…To be happy is to love. To be happy, then, is to suffer.” The paradoxical merging of happiness and suffering can be a feature of depression. Biological Psychiatry, on April 1st, is publishing a new study of regional brain activity using functional magnetic resonance imaging, which may help further our understanding of how happiness and suffering are related in depression.

Stanford University researchers recruited both depressed and non-depressed volunteers to undergo brain scans, via functional magnetic resonance imaging (fMRI), while they participated in an activity where they won and lost money. Dr. Brian Knutson, first author on this article, explains their findings: “When they anticipated winning money, both depressed and nondepressed individuals showed neural activation in the nucleus accumbens, a region implicated in the anticipation of reward.

Only the depressed participants, however, additionally showed increased activation in the anterior cingulate, a region of the brain that has been implicated in conflict.”

John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, notes that this finding indicates that “this complex mixture of findings suggests that depression is not simply the absence of reward, but rather a contamination of neural processing of rewards with features of neural processing of punishments.”

Dr. Knutson agrees, commenting that “these findings are consistent with formulations that depression involves difficulties in the processing of positive information, and suggest more specifically that depressed people actually experience conflict when they are faced with the likelihood of receiving a reward.”

Dr. Krystal concludes that “one intriguing potential implication of this work is that some forms of depression may be experienced, not as the absence of pleasure, but as the ubiquitous presence of emotional pain, disappointment, or frustration.” Dr. Knutson and his colleagues are currently examining whether this increased experience of conflict when anticipating reward hinders recovery from depression.

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Notes to Editors:
The article is “Neural Responses to Monetary Incentives in Major Depression” by Brian Knutson, Jamil P. Bhanji, Rebecca E. Cooney, Lauren Y. Atlas and Ian H. Gotlib. The authors are affiliated with the Department of Psychology at Stanford University in Stanford, California. The article appears in Biological Psychiatry, Volume 63, Issue 7 (April 1, 2008), published by Elsevier.

Full text of the article mentioned above is available upon request. Contact Jayne M. Dawkins at (215) 239-3674 or [email protected] to obtain a copy or to schedule an interview.

About Biological PsychiatryThis international rapid-publication journal is the official journal of the Society of Biological Psychiatry. It covers a broad range of topics in psychiatric neuroscience and therapeutics. Both basic and clinical contributions are encouraged from all disciplines and research areas relevant to the pathophysiology and treatment of major neuropsychiatric disorders. Full-length and Brief Reports of novel results, Commentaries, Case Studies of unusual significance, and Correspondence and Comments judged to be of high impact to the field are published, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Concise Reviews and Editorials that focus on topics of current research and interest are also published rapidly.