Depression and Reward Insensitivity

Closeup of a golden coinsWhy do some people get depressed and what can be done about it? Studies of brain response to rewards suggests that there is a strong link between depression and reward insensitivity. People who are at risk of depression literally don’t react to rewards in  same way as other people.

A large study of adolescent girls without any history of depression found that the lack of the usual brain response to rewards (a reduction in EEG measured reward based electrical activity in the brain) was a significant predictor of depression independent of the current mood of the girls.

In girls with no history of depression, and no current depressive symptoms, a diminished response to reward predicted depression within the following year and a half.

The picture below shows the difference in brain response in girls who did and did not develop depression in the follow up period. reward-response-and-risk-of-depression

As you can see, there is significantly less response in the brains of those who went on to have depression.

This study fits with two other recent studies using a different technique (functional brain imaging using fMRI) that finds that the lack of response to reward often predicts later depression.

What if you think that you may be someone who responds less to reward than others (glass half empty rather than glass half full)?

There may be a way of teaching your brain to notice positive and rewarding stimuli more. This technique is called cognitive bias modification.

It turns out that a relatively simple computer program can help you to notice smiling happy-facesfaces, and there is evidence that using this program regularly reduces both depression and anxiety.

This is the basis for a set of apps from a company called Mental Mint that target depression and anxiety.

These apps are available for both iOS and Android.

For More Information

Attentional Bias Modification Prevents Depression


Electrocortical Responses to Rewards and Emotional Stimuli as Biomarkers of Risk for Depressive Disorders.” American Journal of Psychiatry, 173(12), pp. 1163–1164

Blunted Neural Response to Rewards as a Prospective Predictor of the Development of Depression in Adolescent Girls.” Brady D. Nelson, Greg Perlman, Daniel N. Klein, Roman Kotov, and Greg Hajcak. American Journal of Psychiatry 2016 173:12, 1223-1230
Stringaris A, Vidal-Ribas Belil P, Artiges E, et al: The brain’s response to reward anticipation and depression in adolescence: dimensionality, specificity, and longitudinal predictions in a community-based sample. Am J Psychiatry 2015; 172:1215–1223 Link
Hanson JL, Hariri AR, Williamson DE: Blunted ventral striatum development in adolescence reflects emotional neglect and predicts depressive symptoms. Biol Psychiatry 2015; 78:598–605 CrossRef, Medline

Exercise and Stress – How Exercise Prevents Depression

Exercise and Stress - Karolinska Institute ResearchersExercise seems to reduce stress. But how does this work? And what about exercise effects on depression? An article in the New York Times summarizes a recent publication in the journal Cell which may explain how exercise prevents depression.

A wealth of research shows that regular exercise reduces the risk of depression. A very large study in Britain, for example, suggested that regular exercise reduced the risk of depression by 50%.

Researchers from the Karolinska Institute conducted a series of studies to find out how this effect might occur. They studied mice. As the New York Times notes –

Mouse emotions are, of course, opaque to us. We can’t ask mice if they are feeling cheerful or full of woe. Instead, researchers have delineated certain behaviors that indicate depression in mice. If animals lose weight, stop seeking out a sugar solution when it’s available — because, presumably, they no longer experience normal pleasures — or give up trying to escape from a cold-water maze and just freeze in place, they are categorized as depressed.

And in the new experiment, after five weeks of frequent but intermittent, low-level stress, such as being restrained or lightly shocked, mice displayed exactly those behaviors. They became depressed.

Previous research has shown that aerobic exercise increases the production of an enzyme called PGC-1alpha in muscles, both in mice and in people.

This study identified one particular effect of increased PGC-1alpha: it indirectly increased production of an enzyme that breaks down kynurenine. Kynurenine is a compound that is produced in the body during periods of high stress, and it has been shown to increase inflammation (and other adverse effects of stress) in the brain.

In rats with elevated PGC-1alpha (whether the result of exercise or through direct manipulation) kynurenine disappeared from the body quickly, before it could penetrate the blood-brain barrier.

They then showed that exercise had the same effects on kynurenine in humans who exercised regularly.

To quote the New York Times again –

The upshot of these results, in the simplest terms, is that “you reduce the risk of getting depression when you exercise,” said Maria Lindskog, a researcher in the department of neuroscience at the Karolinska Institute and a study co-author.

Whether the same biochemical processes likewise combat depression that already exists is less certain, said Jorge Ruas, a principal investigator at the Karolinska Institute and the study’s senior author. But he is hopeful. “We think that this mechanism would be efficient if activated after depression has begun,” he said. He and his colleagues hoped to test that possibility in mice soon.

In the meantime, if work and other pressures mount, it may be a good idea to go for a jog. It may just keep your kynurenine in check.

Suicide in Young Adults

Suicide in Young AdultsSuicide in young adults and adolescents is one of the most troubling issues facing any of us dealing with depression.

This post, provided by Yellowbrick, speaks specifically to parents; however, we find that it is a useful resource for all of us who have adolescents and young adults in our lives.

Of particular importance is point number 8; it can be very helpful for someone who is depressed to have loved ones ask about, listen to, and validate their experience and feelings.

For more information about suicide and suicide prevention, please visit San Francisco Suicide Prevention’s website.

Also, feel free to join and participate in our online member’s only forum where this and other topics are discussed in a private forum for other’s who are wrestling with issues related to depression.

Depression and Suicide in Young Adults: A Parent’s Guide

As the third leading cause of death for adolescents and young adults between the ages of 10 and 24, suicide is a vital topic for parents to educate themselves on. While it may feel like an uncomfortable topic, it is important to become familiar with common warning sides in order to make it easier to monitor your teenager and communicate if there is a problem.

Below, we tackle nine common questions regarding depression and suicide in emerging adults. These, as well as the attached infographic by Yellowbrick, can help you feel more comfortable with the subject of suicide, and better informed about its signs, myths, and implications.

  1. What are risk signs for suicide? While studies show that there is no set, reliable indicator of suicide, there are several possible signs to watch for. These include keeping secrets, isolation, depression, and expressions of despair.

  2. Do specific mental illnesses carry a higher risk of suicide? All psychotic illnesses (including disorders like schizophrenia) have a higher rate of suicide, as well as a higher rate of early death from poor health care. Depression, and especially bipolar depression, also carry a higher risk of suicide. Anorexia nervosa has a high rate of death and suicide due to the effects of starvation on mood and judgment.

  3. How do substance abuse and addiction play a role in suicide in emerging adults? Substance abuse accelerates the risk of suicide from other mental illnesses. Overdosing is also a serious health concern, and emerging adults who struggle with substance abuse actually have a three times higher rate of death by overdose than by suicide.

  4. Is suicide genetic? While suicide itself is not genetic, genetic vulnerability plays a role in many mental illnesses and addictions. Family and peer influences may also increase the risk of suicide.

  5. How does a suicide attempt affect mental health? The impact on brain health depends on the method of the attempt and whether there was any direct physical impact on the structure of the brain. Even if there is no brain trauma, there is a gateway effect in the risk-reward center of the brain when a young adult makes an attempt on their own life, and this makes it easier to make a repeat attempt.

  6. What are the social and emotional health concerns following a young adult’s suicide attempt? While this will vary by individual, it’s common for young adults to experience feelings of shame and guilt, which can increase actual or perceived social isolation and feelings of personal failure. This, in turn, can heighten pre-existing emotional tensions.

  7. What steps can young adults take to recover from a suicide attempt? One of the best things that a young adult can do is to seek professional assistance in order to better understand the emotional and neurological contributors to the experience. It’s also important for young adults to repair relationships with friends and family who they may have become isolated from, as well as to return to activities that they find meaningful and enjoyable.

  8. What can parents do to help young adults after a suicide attempt? Although you may be feeling strong emotions after a child’s suicide attempt, it’s important to demonstrate acceptance and a lack of judgment. Offer your support; empathize with your child even if they are angry they survived the attempt (which is common) rather than forcing them to stifle those feelings. Establish a safe, honest, and open communication channel so that your child will feel more comfortable coming to you for help rather than expecting you to read his or her mind.

  9. What suicide prevention methods work for emerging adults? Because isolation is a major risk factor for suicide, it’s important for young adults to rebuild connections, establish healthy channels of communication, and develop strategies to build emotional resilience.


Golden Gate Barrier Debate Highlights Misconceptions about Depression

2014-03-30_17-40-13Several of the readers of this blog sent me a link to an article that appeared in The New York Times this past week that indicated that it was possible or even likely that at the end of May the Golden Gate Bridge district would approve installing a barrier to prevent suicides.

In case you don’t live near here, the Golden Gate Bridge is the number one site in the country for suicide, and anyone who has worked with people with depression can tell you how many people think about jumping from the bridge, at one point or another in their recovery from depression.

The evidence that this would event needless tragedies and suffering is overwhelming and the proposed barrier which would have a minimal effect on the aesthetics of the bridge would cost about 20 million dollars. Which, if you consider that almost 50 people a year die from jumping off the bridge represents about $50,000 per preventable death.

Among the comments in response to the article, several indicated how far we still have to go in addressing stigma against those who suffer from depression.

For example, no amount of science appears to be enough to stop people from saying that there’s no point in building a barrier because people will just use other means.

Studies have shown that if you compare a city like San Francisco that has a high visibility site with a comparable city without such a site that the suicide rate will be higher in the city that has the high visibility site and that the difference will be explained entirely by the additional suicides from the site.

A large study of those extremely rare people who survived has shown that almost none of them make future suicide attempts.

Whereas many people have thought about suicide for a long period of time. The act itself is impulsively made and almost immediately regretted, in almost all cases.

So, congratulations, better late than never. And a special word of appreciation for Dr. Mel Blaustein who has devoted thousands of hours tirelessly lobbying and cajoling the board to make this happen.

For more on this you can follow the link below.

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