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National Academy Urges Changes in Screening and Treatment of Depression 

Stephen Barlas

A National Academy of Sciences (NAS) report urging a more coordinated approach to prevention and treatment of depression in parents-because of its impact on children-hit the streets just as Congress began considering legislation to reform the US health insurance system. The NAS report made a number of recommendations for changing the approach of both public and private health insurers toward depression, although the front-line troops expected to deal with the problem are primary care physicians, who already treat 70 percent of patients with depression.

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Diminished cravings for pleasure linked to core depression symptom

Melanie Moran – Vanderbilt University

New research indicates that decreased cravings for pleasure may be at the root of a core symptom of major depressive disorder. The research is in contrast to the long-held notion that those suffering from depression lack the ability to enjoy rewards, rather than the desire to seek them.

The research, led by Vanderbilt psychologists Michael Treadway and David Zald, is published in the online journal PLoS One.

This initial study shows that decreased reward processing, which is a core symptom of depression, is specifically related to a reduced willingness to work for a reward,” Treadway, a graduate student in psychology, said.

Decreased motivation to seek and experience pleasurable experiences, known as anhedonia, is a primary symptom of major depressive disorder. Anhedonia is less responsive to many antidepressants and often persists after other symptoms of depression subside. However, understanding the different components of anhedonia – the desire to obtain something pleasurable versus experiencing pleasure – has been difficult for researchers to determine in humans.

In the last decade and a half, animal models have found that the neurotransmitter dopamine, long known to be involved in reward processing, is involved in craving or motivation, but not necessarily enjoyment,” Treadway said. “To date, research into reward processing in individuals with anhedonia has focused on enjoyment of rewards, rather than assessing the drive to work for them. We think this task is one of the first to do that.

Treadway and his colleagues devised the Effort-Expenditure for Rewards Task, or EEfRT, to explore the role of reduced desire and motivation in individuals reporting symptoms of anhedonia. EEfRT involved having individuals play a simple video game that gave them a chance to choose between two different tasks, one hard, one difficult, to obtain monetary rewards. Participants were eligible but not guaranteed to receive money each time they completed a task successfully.

The “hard” task required pressing a button 100 times within 21 seconds using one’s non-dominant little finger and carried a potentially higher reward than the easy task, which required pressing a button 30 times in seven seconds using one’s dominant index finger. The subjects were told at the beginning of each trial whether they had a high, medium or low probability of winning a prize if they successfully completed the trial. The participants could choose which trials they completed and were given 20 minutes to perform as many tasks as possible.

The researchers found that subjects who reported symptoms consistent with anhedonia where less willing to make choices requiring greater effort in exchange for greater reward, particularly when the rewards were uncertain.

Consistent with our hypotheses, we found that individuals with self-reported anhedonia made fewer hard-task choices,” the authors wrote. “These findings are consistent with theoretical models linking anhedonia to decreased (dopamine levels).”

By addressing the motivational dimension of anhedonia, our findings suggest a plausible theoretical connection between dopamine deficiency and reward processing in depression, which may eventually help us better understand how anhedonia responds to treatment,” Treadway said.

The study was supported by funding from Vanderbilt University and the National Institute on Drug Abuse.

 

Treadway MT, Buckholtz JW, Schwartzman AN, et al. Worth the ‘EEfRT’? The Effort Expenditure for Rewards Task as an Objective Measure of Motivation and Anhedonia. PLoS ONE 4(8):e6598   [Full text]



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