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Katja Beesdo, PhD; Jennifer Y. F. Lau, PhD; Amanda E. Guyer, PhD; Erin B. McClure-Tone, PhD; Christopher S. Monk, PhD; Eric E. Nelson, PhD; Stephen J. Fromm, PhD; Michelle A. Goldwin, BA; Hans-Ulrich Wittchen, PhD; Ellen Leibenluft, MD; Monique Ernst, MD, PhD; Daniel S. Pine, MD

Arch Gen Psychiatry. 2009;66(3):275-285.

Context  Few studies directly compare amygdala function in depressive and anxiety disorders. Data from longitudinal research emphasize the need for such studies in adolescents.

Objective  To compare amygdala response to varying attention and emotion conditions among adolescents with major depressive disorder (MDD) or anxiety disorders, relative to adolescents with no psychopathology.

Design  Case-control study.

Setting  Government clinical research institute.

Participants  Eighty-seven adolescents matched on age, sex, intelligence, and social class: 26 with MDD (14 with and 12 without anxiety disorders), 16 with anxiety disorders but no depression, and 45 without psychopathology.

Main Outcome Measures  Blood oxygen level–dependent signal in the amygdala, measured by means of event-related functional magnetic resonance imaging. During imaging, participants viewed facial expressions (neutral, fearful, angry, and happy) while attention was constrained (afraid, hostility, and nose-width ratings) or unconstrained (passive viewing).

Results  Left and right amygdala activation differed as a function of diagnosis, facial expression, and attention condition both when patients with comorbid MDD and anxiety were included and when they were excluded (group x emotion x attention interactions, P  .03). Focusing on fearful face–viewing events, patients with anxiety and those with MDD both differed in amygdala responses from healthy participants and from each other during passive viewing. However, both MDD and anxiety groups, relative to healthy participants, exhibited similar signs of amygdala hyperactivation to fearful faces when subjectively experienced fear was rated.

Conclusions  Adolescent MDD and anxiety disorders exhibit common and distinct functional neural correlates during face processing. Attention modulates the degree to which common or distinct amygdala perturbations manifest in these patient groups, relative to healthy peers.

Author Affiliations: Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany (Drs Beesdo and Wittchen); Sections on Development and Affective Neuroscience (Drs Lau, Guyer, McClure-Tone, Nelson, Leibenluft, Ernst, and Pine and Ms Goldwin) and Bipolar Spectrum Disorders (Dr Leibenluft) and Mood and Anxiety Disorders Program (Dr Fromm), National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Department of Psychology and Center for Human Growth and Development, University of Michigan at Ann Arbor (Dr Monk); Department of Experimental Psychology, University of Oxford, Oxford, England (Dr Lau); and Department of Psychology, Georgia State University, Atlanta (Dr McClure-Tone). This report was prepared while Dr Beesdo was a visiting scientist at the National Institute of Mental Health.

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