title: Enhanced subgenual cingulate response to altruistic decisions in remitted major depressive disorder.
abstract: BACKGROUND
  Major depressive disorder (MDD) is associated with functional abnormalities in fronto-meso-limbic networks contributing to decision-making, affective and reward processing impairments. Such functional disturbances may underlie a tendency for enhanced altruism driven by empathy-based guilt observed in some patients. However, despite the relevance of altruistic decisions to understanding vulnerability, as well as everyday psychosocial functioning, in MDD, their functional neuroanatomy is unknown.
  
  
  METHODS
  Using a charitable donations experiment with fMRI, we compared 14 medication-free participants with fully remitted MDD and 15 demographically-matched control participants without MDD.
  
  
  RESULTS
  Compared with the control group, the remitted MDD group exhibited enhanced BOLD response in a septal/subgenual cingulate cortex (sgACC) region for charitable donation relative to receiving simple rewards and higher striatum activation for both charitable donation and simple reward relative to a low level baseline. The groups did not differ in demographics, frequency of donations or response times, demonstrating only a difference in neural architecture.
  
  
  CONCLUSIONS
  We showed that altruistic decisions probe residual sgACC hypersensitivity in MDD even after symptoms are fully remitted. The sgACC has previously been shown to be associated with guilt which promotes altruistic decisions. In contrast, the striatum showed common activation to both simple and altruistic rewards and could be involved in the so-called "warm glow" of donation. Enhanced neural response in the depression group, in areas previously linked to altruistic decisions, supports the hypothesis of a possible association between hyper-altruism and depression vulnerability, as shown by recent epidemiological studies.
authors.affiliation: Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK.
authors.forename: Erdem
authors.initials: E
authors.lastname: Pulcu
authors.affiliation: Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK ; Department of Psychological Medicine, Institute of Psychiatry, King's College London, London SE5 8AF, UK.
authors.forename: Roland
authors.initials: R
authors.lastname: Zahn
authors.affiliation: Cognitive and Behavioural Neuroscience Unit, D'or Institute, Rio de Janeiro, Brazil.
authors.forename: Jorge
authors.initials: J
authors.lastname: Moll
authors.affiliation: Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK.
authors.forename: Paula D
authors.initials: PD
authors.lastname: Trotter
authors.affiliation: Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Thomas
authors.affiliation: Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK ; Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Juhasz
authors.affiliation: Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK.
authors.forename: J F William
authors.initials: JF
authors.lastname: Deakin
authors.affiliation: Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Anderson
authors.affiliation: Department of Psychiatry, MRC Wellcome Trust Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 0QQ, UK.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Sahakian
authors.affiliation: Neuroscience & Psychiatry Unit, Manchester Academic Health Sciences Centre, School of Medicine, University of Manchester, Manchester M13 9PL, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Elliott
mesh_terms: D000328:Adult; D000533:Altruism; D003657:Decision Making / Q000502:physiology*; D003865:Major Depressive Disorder / Q000473:pathology* / Q000523:psychology*; D005260:Female; D006179:Gyrus Cinguli / Q000098:blood supply / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011569:Psychiatric Status Rating Scales; D011930:Reaction Time
chemical_list: D010100:Oxygen
keywords: Charitable donation; Major depression; Reward processing; Striatum; Subgenual anterior cingulate