Reduced Stress-Sensitivity or Increased Reward Experience: The Psychological Mechanism of Response to Antidepressant Medication

Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands.
Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology (Impact Factor: 7.05). 06/2008; 34(4):923-31. DOI: 10.1038/npp.2008.66
Source: PubMed


Depression has often been associated with increased negative affect reactivity to stress (Stress-Sensitivity) and reduced capacity to experience pleasure or positive affect (Reward Experience). To date, no studies have prospectively examined changes in Stress-Sensitivity and Reward Experience following antidepressant treatment. The sample included 83 depressed patients and 22 healthy controls. A randomized controlled trial was carried out with patients receiving either imipramine or placebo for 6 weeks. At baseline and 6 weeks, patients and controls participated in an Experience Sampling procedure, prospectively measuring ecologically valid daily life appraisals of activities and mood states. The course of depression was assessed with the Hamilton Depression Rating Scale (HDRS). Multilevel linear regression analyses showed that patients had higher negative and lower positive appraisals of activities than controls. In addition, patients showed increased Stress-Sensitivity (negative affect reactivity to negatively appraised activities). Treatment with imipramine decreased Stress-Sensitivity and increased Reward Experience (positive affect reactivity to positively appraised activities). Changes in Stress-Sensitivity and Reward Experience were in part reducible to changes in the process of activity appraisal itself. However, increase in Reward Experience, but not decrease in Stress-Sensitivity, discriminated between patients who responded and those who did not, independent of changes in the process of activity appraisal itself. Response to treatment in depression may be conditional on restoration of hedonic capacity, the cerebral substrate of which requires further study in relation to antidepressant response. A search for (synergistic) antidepressant therapies specifically targeting ability to experience reward may be warranted.

Download full-text


Available from: Nancy Nicolson,
  • Source
    • "The famous phrase Panta rhei ( " everything flows " ) from the ancient Greek philosopher Heraclitus indicates that everything changes all the time. This is certainly true for affect: It tends to fluctuate throughout the day, changing from moment to moment as it is being perturbed by external events and our appraisal of these (e.g., Butler, 2015; Montpetit, Bergeman, Deboeck, Tiberio, & Boker, 2010; Wichers et al., 2009). In addition, affect steers our motivation and behavior, and thus contributes to shaping our subsequent experiences. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The current article aims to provide an up-to-date synopsis of available techniques to study affect dynamics using intensive longitudinal data (ILD). We do so by introducing the following eight dichotomies that help elucidate what kind of data one has, what process aspects are of interest, and what research questions are being considered: (1) single- versus multiple-person data; (2) univariate versus multivariate models; (3) stationary versus nonstationary models; (4) linear versus nonlinear models; (5) discrete time versus continuous time models; (6) discrete versus continuous variables; (7) time versus frequency domain; and (8) modeling the process versus computing descriptives. In addition, we discuss what we believe to be the most urging future challenges regarding the modeling of affect dynamics.
    Emotion Review 07/2015; 7(4). DOI:10.1177/1754073915590619 · 2.90 Impact Factor
    • "Harmer et al., 2009; Rawlings et al., 2010), and recent studies suggest that changes in positive rather than negative emotions may be important in predicting recovery from depression (Cohn et al., 2009; Wichers et al., 2009, 2010). For example, recovery from depression was associated with an increase in the ability to experience reward in daily life (Wichers et al., 2009). A high ability to experience positive emotions in daily life was also associated with increased resilience against the development of affective symptoms (Wichers et al., 2010), with positive, but not negative, emotions predicting psychological resilience (Cohn et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Early improvement in positive emotions-more than decreases in negative emotions-was highly predictive of treatment response in an ecologically valid prospective manner. This result needs replication with simpler assessments to determine whether it can be translated into clinical practice. 2049 adult depressed outpatients receiving agomelatine were assessed at inclusion, week 2, and week 6 using the clinician-rated Quick Inventory of Depressive Symptomatology, Sheehan Disability Scale, Clinical Global Impression scale, and Multidimensional Assessment of Thymic States (MATHYS), an auto-questionnaire rating the frequency of emotions, including sadness and joy, over the previous week. Joy and sadness had a relatively low correlation coefficient at baseline (r=-0.277), joy (r=-0.160) being less correlated with clinical severity than sadness (r=0.317). An increase in joy at week 2 had higher specificity (85.04%) and positive predictive value (70.55%) for treatment response than decreased sadness (57.92% and 66.04%, respectively), and the global capacity of the former to predict remission, either clinical (Yule Q coefficient, 39.96%) or functional (44.35%), was even better compared to the prediction of clinical response (37.38%). MATHYS retrospectively assesses emotions, with five possible ratings only, relying on self-rated frequencies. With only a 6-week follow-up, conclusions are limited to short-term aspects of clinical and functional remission. Early improvement in joy during the first 2 weeks of treatment is strongly specific for treatment response and remission. The frequency of joy captures the predictivity and may deserve further study regarding inclusion in depressive rating scales. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 06/2015; 185:97-103. DOI:10.1016/j.jad.2015.06.019 · 3.38 Impact Factor
  • Source
    • "Event-and activity stress The increased NA-reactivity to activity-related stress in nonremitted depressed participants was significant higher than in healthy never depressed individuals. This finding is in concordance with the study of Wichers et al. (2009). Taken together, these Table 4 Multilevel estimates of daily stress (negative event, activity, and social stress) Â group (non-remitted and remitted MDD patients at follow-up and healthy controls) on positive and negative mood states (PA and NA). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Little is known about how daily life mood reactivity to minor stressors (stress reactivity) might change following major depressive disorder (MDD) treatment. We investigate whether (i) mood states and appraisals of daily stressors change after treatment; (ii) stress reactivity to event, activity, or social stress differs; (iii) stress reactivity depends on severity of residual depressive symptoms; and (iv) stress reactivity in individuals with remitted or non-remitted depression differ from that of never-depressed individuals. Thirty depressed individuals participated in an experience sampling study before and after a treatment period of 18 months; 39 healthy individuals formed a comparison group. Reactivity of positive affect (PA) and negative affect (NA) to daily stressors were measured. More residual symptoms were associated with larger NA responses to stress. Compared to healthy controls, participants with non-remitted MDD showed higher NA-reactivity to all stressors. In contrast, stress reactivity to event and activity stressors was normalized in remitted patients. However, they still showed heightened NA-reactivity to social stress. Greater stress reactivity to event and activity stress appears to be state-dependent. The heightened social stress reactivity in remitted patients suggests that sensitivity to social stress may reflect an underlying vulnerability in MDD. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    European Psychiatry 04/2015; 30(4). DOI:10.1016/j.eurpsy.2015.02.011 · 3.44 Impact Factor
Show more