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Hyper-responsivity to losses in the anterior insula during economic choice scales with depression severity

Published online by Cambridge University Press:  07 June 2017

J. B. Engelmann ,
G. S. Berns  and
B. W. Dunlop
J. B. Engelmann
Affiliation:
Center for Research in Experimental Economics and Political Decision Making (CREED), Amsterdam School of Economics, University of Amsterdam and The Tinbergen Institute, Amsterdam, The Netherlands Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, EN Nijmegen, The Netherlands
G. S. Berns
Affiliation:
Department of Psychology, Emory University, Atlanta, GA, USA
B. W. Dunlop*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, USA
*
*Address for correspondence: B. W. Dunlop, M.D., Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park NE, 3rd Floor, Atlanta, GA 30329, USA. (Email: bdunlop@emory.edu)
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Abstract

Background

Commonly observed distortions in decision-making among patients with major depressive disorder (MDD) may emerge from impaired reward processing and cognitive biases toward negative events. There is substantial theoretical support for the hypothesis that MDD patients overweight potential losses compared with gains, though the neurobiological underpinnings of this bias are uncertain.

Methods

Twenty-one unmedicated patients with MDD were compared with 25 healthy controls (HC) using functional magnetic resonance imaging (fMRI) together with an economic decision-making task over mixed lotteries involving probabilistic gains and losses. Region-of-interest analyses evaluated neural signatures of gain and loss coding within a core network of brain areas known to be involved in valuation (anterior insula, caudate nucleus, ventromedial prefrontal cortex).

Results

Usable fMRI data were available for 19 MDD and 23 HC subjects. Anterior insula signal showed negative coding of losses (gain > loss) in HC subjects consistent with previous findings, whereas MDD subjects demonstrated significant reversals in these associations (loss > gain). Moreover, depression severity further enhanced the positive coding of losses in anterior insula, ventromedial prefrontal cortex, and caudate nucleus. The hyper-responsivity to losses displayed by the anterior insula of MDD patients was paralleled by a reduced influence of gain, but not loss, stake size on choice latencies.

Conclusions

Patients with MDD demonstrate a significant shift from negative to positive coding of losses in the anterior insula, revealing the importance of this structure in value-based decision-making in the context of emotional disturbances.

Keywords

Attentioncaudatedecision-makingdepressioninsulaloss aversionneuroeconomics
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 16 , December 2017 , pp. 2879 - 2891
Copyright
Copyright © Cambridge University Press 2017 

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