Measuring change in anhedonia using the "Happy Faces" task pre- to post-repetitive transcranial magnetic stimulation (rTMS) treatment to left dorsolateral prefrontal cortex in Major Depressive Disorder (MDD): relation to empathic happiness

Sharee N Light, Linas A Bieliauskas, Stephan F Taylor, Sharee N Light, Linas A Bieliauskas, Stephan F Taylor

Abstract

We investigated whether repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) would reduce anhedonia in a sample of 19 depressed adults (Mage = 45.21, SD = 11.21, 63% women) randomized to either active or sham rTMS. To track anhedonia, patients completed the Snaith-Hamilton Pleasure Scale (SHAPS)1 and a novel behavioral task called "Happy Faces," which required patients to interpret neutral versus various intensities of positively valenced human facial expressions. Patients had to indicate dichotomously whether any degree of positive emotion was expressed. We expected that more anhedonic patients would struggle most with low intensity happy faces; often incorrectly calling them neutral. Patients also completed a self-report measure of "empathic happiness"-i.e., vicarious joy. Measures were completed pre- to post-treatment. Results indicate rTMS to DLPFC related to improvement in interpretation of subtle forms of happiness in active rTMS patients relative to sham. Furthermore, empathic happiness and anhedonia score were significantly antagonistic across all patients.

Conflict of interest statement

Dr. Taylor has received research support from Neuronetics, which funded part of this research, and St. Jude Medical (now Abbott). The remaining authors declare that they have no conflict of interest.

Figures

Fig. 1. Examples of Happy Faces Task…
Fig. 1. Examples of Happy Faces Task stimuli.
During the “Happy Faces” Task, participants viewed randomly ordered pictures of human faces displaying either neutral affect or varying degrees of positive affect
Fig. 2. Significant Time × Low Intensity…
Fig. 2. Significant Time × Low Intensity Happy Faces Accuracy interaction.
a Covariates appearing in the model are evaluated at the following values: MADRS score at screening = Mean, SHAPS Decline = 0, age = mean years. b Covariates appearing in the model are evaluated at the following values: MADRS score at screening = mean, SHAPS Decline = 10, age = mean years
Fig. 3. Significant Time × Low Intensity…
Fig. 3. Significant Time × Low Intensity Happy Faces Reaction Time interaction.
a Covariates appearing in the model are evaluated at the following values: MADRS score at Baseline = 27, SHAPS Decline = 10, age = mean years. b Covariates appearing in the model are evaluated at the following values: MADRS score at Baseline = 18 (minimum for study entry), SHAPS Decline = 10, age = mean years
Fig. 4. Partial regression plot.
Fig. 4. Partial regression plot.
The greater the increase in trait Light-Moran Empathic Happiness subscale score from Time 1 to Time 2, the greater the increase in hedonic tone (i.e. the greater the reduction in anhedonia) from Time 1 to Time 2, even with MADRS screening score entered as a co-variate (ß = 0.563, t = 2.63; p < 0.05; Adjusted R2 = 22%)

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