title: Aberrant brain responses to emotionally valent words is normalised after cognitive behavioural therapy in female depressed adolescents.
abstract: BACKGROUND
  Depression in adolescence is debilitating with high recurrence in adulthood, yet its pathophysiological mechanism remains enigmatic. To examine the interaction between emotion, cognition and treatment, functional brain responses to sad and happy distractors in an affective go/no-go task were explored before and after Cognitive Behavioural Therapy (CBT) in depressed female adolescents, and healthy participants.
  
  
  METHODS
  Eighty-two Depressed and 24 healthy female adolescents, aged 12-17 years, performed a functional magnetic resonance imaging (fMRI) affective go/no-go task at baseline. Participants were instructed to withhold their responses upon seeing happy or sad words. Among these participants, 13 patients had CBT over approximately 30 weeks. These participants and 20 matched controls then repeated the task.
  
  
  RESULTS
  At baseline, increased activation in response to happy relative to neutral distractors was observed in the orbitofrontal cortex in depressed patients which was normalised after CBT. No significant group differences were found behaviourally or in brain activation in response to sad distractors. Improvements in symptoms (mean: 9.31, 95% CI: 5.35-13.27) were related at trend-level to activation changes in orbitofrontal cortex.
  
  
  CONCLUSIONS
  In the follow-up section, a limited number of post-CBT patients were recruited.
  
  
  CONCLUSIONS
  To our knowledge, this is the first fMRI study addressing the effect of CBT in adolescent depression. Although a bias toward negative information is widely accepted as a hallmark of depression, aberrant brain hyperactivity to positive distractors was found and normalised after CBT. Research, assessment and treatment focused on positive stimuli could be a future consideration. Moreover, a pathophysiological mechanism distinct from adult depression may be suggested and awaits further exploration.
authors.affiliation: Department of Psychiatry, University of Cambridge. Electronic address: jc756@cam.ac.uk.
authors.forename: Jie-Yu
authors.initials: JY
authors.lastname: Chuang
authors.affiliation: Department of Psychiatry, University of Cambridge.
authors.forename: Kirstie
authors.initials: K
authors.lastname: J Whitaker
authors.affiliation: Department of Psychiatry, University of Cambridge; Behavioural and Clinical Neuroscience Institute, University of Cambridge; Cambridgeshire and Peterborough NHS Foundation Trust.
authors.forename: Graham K
authors.initials: GK
authors.lastname: Murray
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Elliott
authors.affiliation: Department of Psychiatry, University of Cambridge; Department of Psychology, Columbia University.
authors.forename: Cindy C
authors.initials: CC
authors.lastname: Hagan
authors.affiliation: Department of Psychiatry, University of Cambridge.
authors.forename: Julia Me
authors.initials: JM
authors.lastname: Graham
authors.affiliation: Department of Psychiatry, University of Cambridge.
authors.forename: Cinly
authors.initials: C
authors.lastname: Ooi
authors.affiliation: Behavioural and Clinical Neuroscience Institute, University of Cambridge.
authors.forename: Roger
authors.initials: R
authors.lastname: Tait
authors.affiliation: Department of Psychiatry, University of Cambridge.
authors.forename: Rosemary J
authors.initials: RJ
authors.lastname: Holt
authors.affiliation: University of Cambridge.
authors.forename: Adrienne O
authors.initials: AO
authors.lastname: van Nieuwenhuizen
authors.affiliation: School of psychology and Clinical language Sciences, University of Reading.
authors.forename: Shirley
authors.initials: S
authors.lastname: Reynolds
authors.affiliation: Department of Psychiatry, University of Cambridge.
authors.forename: Paul O
authors.initials: PO
authors.lastname: Wilkinson
authors.affiliation: Department of Psychiatry, University of Cambridge.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Bullmore
authors.affiliation: Department of Psychiatry, University of Oxford.
authors.forename: Belinda R
authors.initials: BR
authors.lastname: Lennox
authors.affiliation: Department of Psychiatry, University of Cambridge; Behavioural and Clinical Neuroscience Institute, University of Cambridge.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Sahakian
authors.affiliation: Department of Psychiatry, University of Cambridge.
authors.forename: Ian
authors.initials: I
authors.lastname: Goodyer
authors.affiliation: Department of Psychiatry, University of Cambridge; Behavioural and Clinical Neuroscience Institute, University of Cambridge; Cambridgeshire and Peterborough NHS Foundation Trust.
authors.forename: John
authors.initials: J
authors.lastname: Suckling
mesh_terms: D000293:Adolescent; D001288:Attention / Q000502:physiology; D001921:Brain / Q000473:pathology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000503:physiopathology* / Q000628:therapy*; D004644:Emotions / Q000502:physiology; D005260:Female; D006240:Happiness; D006801:Humans; D008279:Magnetic Resonance Imaging; D010775:Photic Stimulation / Q000379:methods; D017397:Prefrontal Cortex / Q000473:pathology*; D016896:Treatment Outcome
keywords: Adolescent depression; Cognitive behaviour therapy; Functional magnetic resonance imaging; Positive stimuli