Towards a Neuroimaging Biomarker of Depression Vulnerability

Major depressive disorder (MDD) is a pervasive and debilitating illness, with a recurrent course and chronic prognosis. Although efective treatments for MDD exist, there is a pressing need to characterize relapse vulnerability in order to design efective prophylactic care. To date, heterogeneity within depression neuroimaging research has made it di cult to establish a reliable biomarker of disorder susceptibility. In this paper, we review neuroimaging evidence for the assessment of MDD vulnerability, theorizing that current indings can be broadly distinguished between those indicating the presence of depressive episodes and those indicating MDD vulnerability during symptom remission. We argue that unlike the amygdala hyperactivity and prefrontal hypoactivity observed during MDD episodes, prefrontal hyperactivity may be a characteristic of dysphoric cognition during symptom remission that indicates MDD vulnerability and relapse risk. Drawing on current research of normative emotion regulation, we describe a potential test of MDD vulnerability, employing emotional challenge paradigms that induce cognitive reactivity the increased endorsement of negative self-descriptions during a transient dysphoric mood. Relative to a normative model of prefrontal function, the neuroimaging assessment of cognitive reactivity may provide a reliable indicator of MDD vulnerability, advancing the ield of biomarker research as well as the delivery of preventative treatment on an individual basis.