Differential precuneus and frontal activity associated with facial emotion processing in adolescent depression

Adolescence is a critical period of vulnerability to mental health issues, yet emotion processing in adolescent depression remains understudied. This task-based functional Magnetic Resonance Imaging (fMRI) study examines emotion processing in depressed adolescents and the effects of Cognitive Behavioural Therapy (CBT). fMRI data were collected during an emotional face processing task from 94 depressed adolescents and 34 healthy controls at baseline. As part of a feasibility study, a longitudinal sub-cohort of 14 depressed adolescents and 33 controls underwent follow-up scans after 24 weeks of CBT. Whole-brain analyses estimated: (a) neural responses to overall facial emotions, and (b) a dynamic range of responses to varying emotion intensities. At baseline, depressed adolescents exhibited greater precuneus activity for positive emotions and hypoactivity in the frontal pole for negative emotions, both correlating with trait anxiety. Although CBT did not significantly alter neural responses in the smaller follow-up sample, behavioural data indicated that depressed adolescents rated high-intensity sad faces as less sad post-treatment. These findings underscore the importance of early interventions targeting emotional biases in adolescent depression. Future studies with larger samples are needed to clarify neural mechanisms of treatment effects.