Predicting therapeutic response in depressed teen girls


Philadelphia, September 16, 2020 – The risk of developing major depressive disorder (MDD) surges during adolescence-particularly for girls. Cognitive behavioral therapy (CBT) can be an effective treatment, but only about half of girls diagnosed with depression show significant improvement. Researchers at Harvard Medical School and McLean Hospital have now identified a non-invasive test of brain function that could help predict who will respond to CBT.

The article, appears in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier.

“The study is very significant because it suggests that readily acquired EEG measures related to processing of rewards and losses can serve as biomarkers for predicting treatment response and tracking the effects of therapy in the brain,” said Cameron Carter, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. “Future work using these measures may help clinicians determine the best treatment – for example, CBT versus medications – for a given young person suffering with depressive symptoms.”

The study included 36 teenage girls with MDD and 33 healthy control adolescents. Girls with MDD were offered a 12-week course of CBT. Overall, the girls who underwent treatment saw a significant improvement in their symptoms from the “severe” to “mild” range.

At the start of the study, all participants were assessed for mental health and were given a task, much like a video game, in which they could win or lose money. The researchers used electroencephalography (EEG), which measures brain activity from outside the skull, to test participants’ brain responses during the task. The girls repeated the task (and the EEG test) at the midpoint of treatment, and again after completion of treatment. Control participants, who did not receive CBT, also performed the task and EEG measurements at three corresponding times.

The researchers measured brain signals called event-related potentials (ERP), which are signature responses seen during such tasks. One type of ERP reflects the brain’s immediate response to monetary rewards vs. losses; this measure did not predict who would respond to CBT. Another, longer-lasting type of ERP reflects the brain’s more sustained emotional processing of rewards vs. losses.

“We found that the brain measure of sustained – but not initial – responsiveness to rewards predicted greater symptom improvement, which may help to inform which depressed adolescents are most likely to benefit from CBT,” said Christian Webb, PhD, lead author of the study.

The girls with a larger ERP response showed greater improvement in symptoms.

Although the precise mechanisms that account for symptom improvement in CBT for depressed teens is not yet clear, this study also revealed that EEG responses to monetary loss changed over time with treatment. That finding, Dr. Webb said, may reflect that, “in addition to reducing depressive symptoms, successful CBT may attenuate underlying neural hypersensitivity to negative outcomes among depressed adolescent girls,” ultimately leading to symptom improvement.


Notes for editors

The article is “Reward-related neural predictors and mechanisms of symptom change in cognitive behavioral therapy for depressed adolescent girls,” by Christian Webb, Randy Auerbach, Erin Bondy, Colin Stanton, Lindsay Appleman, Diego Pizzagalli ( It appears as an Article in Press in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier.

Copies of this paper are available to credentialed journalists upon request; please contact Rhiannon Bugno at or +1 254 522 9700. Journalists wishing to interview the authors may contact the PIO at Harvard at and Christian Webb at or 011- 617-855-4429.

The authors’ affiliations and disclosures of financial and conflicts of interests are available in the article.

Cameron S. Carter, MD, is Professor of Psychiatry and Psychology and Director of the Center for Neuroscience at the University of California, Davis. His disclosures of financial and conflicts of interests are available here.

About Biological Psychiatry: Cognitive Neuroscience and Neuroimaging

Biological Psychiatry: Cognitive Neuroscience and Neuroimaging is an official journal of the Society of Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal focuses on studies using the tools and constructs of cognitive neuroscience, including the full range of non-invasive neuroimaging and human extra- and intracranial physiological recording methodologies. It publishes both basic and clinical studies, including those that incorporate genetic data, pharmacological challenges, and computational modeling approaches.

About Elsevier

Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray’s Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers.

Media contact

Rhiannon Bugno, Editorial Office

Biological Psychiatry: Cognitive Neuroscience and Neuroimaging

+1 254 522 9700

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