Differences in Reward and Punishment Sensitivity among Adolescents with Depression Varying in Manic Symptoms

Adolescent depression is heterogeneous. Given maturational changes in reward systems during adolescence, we examined how differences in reward sensitivity (RS) and punishment sensitivity (PS) relate to the presence of manic symptoms during depressive episodes (i.e., mixed features depression) in adolescents. Participants included 161 12-18 year-olds (104 assigned female at birth), including 124 with moderate to high levels of depression (DEP_nomix) of which 54 endorsed mixed features (DEP_mix), and 37 healthy controls (HC). We compared groups based on their questionnaire and behavioral measures of RS and PS. Compared to HC, DEP_mix and DEP_nomix had trait RS characterized by higher impulsivity (p's < .001; η² = .21) and lower reward responsiveness (p's < .003-.006; η² = .08), as well as higher trait PS (p's < .001; η² = .08). DEP_mix had higher RS drive than DEP_nomix when controlling for acuity of mixed features (p < .05). These results indicate the potential utility of integrative treatments that can target both excesses and deficits in RS, particularly in youth with DEP_mix.