Psychological Medicine

Original Articles

Abnormal prefrontal activity subserving attentional control of emotion in remitted depressed patients during a working memory task with emotional distracters

R. Kerestesa1a2 c1, C. D. Ladouceura3, S. Medaa4, P. J. Nathana2a5, H. P. Blumberga1, K. Maloneya1, B. Rufa1, A. Sariciceka1, G. D. Pearlsona1a4, Z. Bhagwagara1a6 and M. L. Phillipsa3a7

a1 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

a2 School of Psychology and Psychiatry, Monash University Clayton Campus, Melbourne, Australia

a3 Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

a4 Olin Neuropsychiatry Research Center, Hartford, CT, USA

a5 Brain Mapping Unit, Department of Psychiatry, University of Cambridge, UK

a6 Bristol Myers Squibb, Wallingford, CT, USA

a7 Department of Psychological Medicine, Cardiff University School of Medicine, Cardiff, UK


Background Patients with major depressive disorder (MDD) show deficits in processing of facial emotions that persist beyond recovery and cessation of treatment. Abnormalities in neural areas supporting attentional control and emotion processing in remitted depressed (rMDD) patients suggests that there may be enduring, trait-like abnormalities in key neural circuits at the interface of cognition and emotion, but this issue has not been studied systematically.

Method Nineteen euthymic, medication-free rMDD patients (mean age 33.6 years; mean duration of illness 34 months) and 20 age- and gender-matched healthy controls (HC; mean age 35.8 years) performed the Emotional Face N-Back (EFNBACK) task, a working memory task with emotional distracter stimuli. We used blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to measure neural activity in the dorsolateral (DLPFC) and ventrolateral prefrontal cortex (VLPFC), orbitofrontal cortex (OFC), ventral striatum and amygdala, using a region of interest (ROI) approach in SPM2.

Results rMDD patients exhibited significantly greater activity relative to HC in the left DLPFC [Brodmann area (BA) 9/46] in response to negative emotional distracters during high working memory load. By contrast, rMDD patients exhibited significantly lower activity in the right DLPFC and left VLPFC compared to HC in response to positive emotional distracters during high working memory load. These effects occurred during accurate task performance.

Conclusions Remitted depressed patients may continue to exhibit attentional biases toward negative emotional information, reflected by greater recruitment of prefrontal regions implicated in attentional control in the context of negative emotional information.

(Received February 04 2011)

(Revised May 16 2011)

(Accepted May 20 2011)

(Online publication July 07 2011)


c1 Address for correspondence: Miss R. Kerestes, School of Psychology and Psychiatry, Monash University Clayton Campus, Wellington Road, Clayton, Melbourne Victoria, Australia. (