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Incentive salience: novel treatment strategies for major depression

Published online by Cambridge University Press:  01 August 2013

David P. Soskin*
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
Daphne J. Holt
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
Garret R. Sacco
Department of Psychology, University of Delaware, Newark, Delaware, USA
Maurizio Fava
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
*Address for correspondence: Dr. D. Soskin, Center for Treatment-Resistant Depression, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Boston, MA 02114, USA. (Email


This article proposes that a recent shift in our understanding of dopamine function may support translational research to target deficits in positive emotions and reward processing in individuals with major depressive disorder (MDD). We review how dopamine functions to modulate approach behaviors in response to positive incentives, and we describe the incentive salience hypothesis, which posits that dopamine primarily modulates “wanting,” or anticipatory reward, rather than “liking,” or subjective pleasure. Although the incentive salience hypothesis was first proposed to help explain how drugs of abuse may reinforce harmful behaviors in the absence of continued pleasure or “liking,” it may also provide a basis for understanding and developing new treatment approaches for MDD. Specifically, it provides a rationale for combining behaviorally activating psychotherapies and pro-dopaminergic agents to target impaired reward processing in MDD.

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Copyright © Cambridge University Press 2013 

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