Brain’s Reward Response Predicts Which Young Adults Seeking Mental Health Care Will Show Improvement Six Months Later, Finds Study by Eckstrand, Phillips and Colleagues

Young adulthood is an especially vulnerable time in development when symptoms of mental illness frequently arise. In fact, nearly one in five people between the ages of 18 and 25 seeks help for symptoms related to depression and anxiety. One particularly common and debilitating symptom is anhedonia, the inability to experience pleasure. A recent study by Pitt Department of Psychiatry researchers is the first to show that a neural signal in a reward-related brain region can predict which young adults with mental health symptoms will have improved anhedonia—and life satisfaction—six months later.

The new study by Child and Adolescent Psychiatry Fellow Kristen Eckstrand, MD, PhD, and Professor of Psychiatry and Clinical and Translational Science Mary Phillips, MD, and colleagues, was published in JAMA Psychiatry

Previous research found that adolescents who showed weaker responses in their ventral striatum, a part of the brain’s reward signaling pathway, when they anticipated receiving a monetary reward were more likely to have anhedonia in the future. In the new study, Drs. Eckstrand and Phillips wanted to see if the same results would be replicated with young adults. They also hoped to expand on the finding to determine whether activity in the ventral striatum could predict meaningful improvements in quality of life.

“Quality of life has many implications, not just for the emotions that one feels internally, but how a person is able to interact with the outside world,” said Dr. Eckstrand. “It impacts whether people are able to work full-time jobs and whether they're able to sustain meaningful relationships.”

To study the connection between reward processing in the ventral striatum, anhedonia, and quality of life, the researchers recruited 52 young adults who had sought help for mental health symptoms. Using functional magnetic resonance imaging (fMRI), Dr. Eckstrand, Dr. Phillips and colleagues measured activity in the ventral striatum while the young adults completed a card-guessing task that involved receiving monetary rewards.

Participants also filled out surveys about their symptoms and their quality of life, such as how they were functioning at work or in their relationships. Six months later, they returned to the clinic and filled out the surveys again. In the interim, they were able to pursue treatment for their symptoms.

Notably, the study included participants with a wide range of symptoms, not just those diagnosed with major depressive disorder. “Because of this breadth, the results of our study may have relevance for helping a variety of patients, including those without a traditional diagnosis,” said Dr. Phillips.

The researchers found that increased ventral striatum activity in response to reward was associated with improvements in anhedonia and life satisfaction six months later. In addition, the reduction in anhedonia completely accounted for the improvement in life satisfaction. This association may have relevance for clinical care. “Our results suggest that treating anhedonia may be a really good way to improve someone’s overall quality of life,” said Dr. Eckstrand. 

These findings also suggest that developing treatments that target activity in the ventral striatum might be helpful for alleviating anhedonia and other psychiatric symptoms. An exciting possibility is that early intervention using this type of treatment in young adulthood may have lasting benefits. “We may be able to not just impact a short-term course of mental health symptoms; ventral striatum-targeting treatments may be able to really shape one's lifetime mental health,” said Dr. Eckstrand. 

Anhedonia Reduction and the Association Between Left Ventral Striatal Reward Response and 6-Month Improvement in Life Satisfaction Among Young Adults
Eckstrand KL, Forbes EE, Bertocci MA, Chase HW, Greenberg T, Lockovich J, Stiffler R, Aslam HA, Graur S, Bebko G, Phillips ML
JAMA Psychiatry, 2019, DOI: 10.1001/jamapsychiatry.2019.0864