Reward Behavior Disengagement, a Neuroeconomic Model-Based Objective Measure of Reward Pathology in Depression: Findings from the EMBARC Trial

Michael A Giles; Crystal M Cooper; Manish K Jha; Cherise R Chin Fatt; Diego A Pizzagalli; Taryn L Mayes; Christian A Webb; Tracy L Greer; Amit Etkin; Joseph M Trombello; Henry W Chase; Mary L Phillips; Melvin G McInnis; Thomas Carmody; Phillip Adams; Ramin V Parsey; Patrick J McGrath; Myrna Weissman; Benji T Kurian; Maurizio Fava; Madhukar H Trivedi

doi:10.3390/bs13080619

Reward Behavior Disengagement, a Neuroeconomic Model-Based Objective Measure of Reward Pathology in Depression: Findings from the EMBARC Trial

Behav Sci (Basel). 2023 Jul 25;13(8):619. doi: 10.3390/bs13080619.

Authors

Michael A Giles¹, Crystal M Cooper^{2

3}, Manish K Jha², Cherise R Chin Fatt², Diego A Pizzagalli^{4

5}, Taryn L Mayes², Christian A Webb^{4

5}, Tracy L Greer^{2

6}, Amit Etkin⁷, Joseph M Trombello², Henry W Chase⁸, Mary L Phillips⁸, Melvin G McInnis⁹, Thomas Carmody¹⁰, Phillip Adams¹¹, Ramin V Parsey¹², Patrick J McGrath¹¹, Myrna Weissman¹¹, Benji T Kurian¹, Maurizio Fava^{4

13}, Madhukar H Trivedi²

Affiliations

¹ Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
² Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
³ Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX 76104, USA.
⁴ Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA.
⁵ McLean Hospital, Belmont, MA 02478, USA.
⁶ Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, USA.
⁷ Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA.
⁸ Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
⁹ Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA.
¹⁰ Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
¹¹ Department of Psychiatry, Columbia University, New York, NY 10032, USA.
¹² Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, NY 11794, USA.
¹³ Massachusetts General Hospital, Boston, MA 02114, USA.

Abstract

The probabilistic reward task (PRT) has identified reward learning impairments in those with major depressive disorder (MDD), as well as anhedonia-specific reward learning impairments. However, attempts to validate the anhedonia-specific impairments have produced inconsistent findings. Thus, we seek to determine whether the Reward Behavior Disengagement (RBD), our proposed economic augmentation of PRT, differs between MDD participants and controls, and whether there is a level at which RBD is high enough for depressed participants to be considered objectively disengaged. Data were gathered as part of the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study, a double-blind, placebo-controlled clinical trial of antidepressant response. Participants included 195 individuals with moderate to severe MDD (Quick Inventory of Depressive Symptomatology (QIDS-SR) score ≥ 15), not in treatment for depression, and with complete PRT data. Healthy controls (n = 40) had no history of psychiatric illness, a QIDS-SR score < 8, and complete PRT data. Participants with MDD were treated with sertraline or placebo for 8 weeks (stage I of the EMBARC trial). RBD was applied to PRT data using discriminant analysis, and classified MDD participants as reward task engaged (n = 137) or reward task disengaged (n = 58), relative to controls. Reward task engaged/disengaged groups were compared on sociodemographic features, reward-behavior, and sertraline/placebo response (Hamilton Depression Rating Scale scores). Reward task disengaged MDD participants responded only to sertraline, whereas those who were reward task engaged responded to sertraline and placebo (F(1293) = 4.33, p = 0.038). Reward task engaged/disengaged groups did not differ otherwise. RBD was predictive of reward impairment in depressed patients and may have clinical utility in identifying patients who will benefit from antidepressants.

Keywords: anhedonia; major depressive disorder; probabilistic reward task; reward engagement; treatment response.

Abstract

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