Abstract

Along with many other scientific fields, psychiatry – and neuroscience more generally – has been transformed by the digital revolution. Brain imaging now has a central role in the development of our understanding in psychophysiological processes that are widely accepted as forming the biological substrate for clinical phenotypes. Major Depressive Disorder (MDD) in adult populations is now well characterised in terms of brain structure and function from quantitative meta-analyses of the extant literature, with varying degrees of support for current neurobiological models.

MR-IMPACT is a Medical Research Council funded adjunctive study to the IMPACT (improving mood with psychoanalytic therapy or cognitive behaviour therapy) clinical trial. Whilst post-treatment follow-up assessments are ongoing, baseline (pre-treatment) data are available for 128 patients (aged 12-17 years) and 40 matched control participants. Assessments include magnetic resonance imaging (MRI) of anatomy, functional MRI during tasks sensitive to affective bias in memory, response inhibition and facial processing as well as during task-absent (i.e. rest) conditions.

Preliminary results indicate some main effects of brain connectivity, but also that the trajectories during adolescence of brain structure and function, as well as cognition, are altered in MDD . Bearing in mind the strong prior literature on the importance of early years experiences to the prevalence of MDD in later life, and the well established brain changes associated with MDD in adulthood, the emergence of depressive symptoms during the second decade of life appears to be mediated by altered trajectories off brain maturation kindled by pre-existing vulnerabilities.