Emotional Responses and Emotion Regulation in Drug-Free Women with Major Depressive Disorder

Major depressive disorder (MDD) is marked by increased negative emotions and decreased positive emotions, indicating impaired emotion regulation. This study aimed to examine emotional responses to positive and negative visual stimuli in drug-free female patients with MDD compared to healthy controls and to explore the connection between these responses and emotion regulation strategies.

Forty-six drug-free female patients diagnosed with MDD and 40 age and educational level-matched healthy women were included. All participants underwent structured psychiatric interviews (SCID) and completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Emotion Regulation Questionnaire (ERQ). Emotional responses to six basic emotions (sadness, disgust, anger, fear, happiness, surprise) were assessed during two block-design slide sessions using images from the International Affective Picture System (IAPS). Emotional response intensity was analyzed with repeated measures ANOVA, controlling for baseline emotion scores, menstrual cycle phase, and stimulus order.

Across the experiment, patients reported significantly higher overall levels of sadness (F=56.7, p<0.001), disgust (F=22.3, p<0.001), anger (F=31.4, p<0.001), fear (F=48.7, p<0.001), and surprise (F=6.7, p=0.01), and lower overall levels of happiness (F=47.4, p<0.001) compared with controls across the experiment. When baseline levels were covaried, patients exhibited heightened reactivity to negative stimuli, specifically in disgust (F=11.7, p=0.001), anger (F=4.3, p=0.04), and fear (F=14.6, p<0.001), while responses to sadness and surprise did not differ. Furthermore, when baseline emotional states were controlled, emotional reactivity to positive stimuli, including happiness, did not differ between groups.

Contrary to a generalized emotion context insensitivity hypothesis, our findings demonstrate emotion-specific dysregulation in MDD. Drug-free female patients showed heightened reactivity to negative stimuli in terms of disgust, anger, and fear, but not sadness or surprise. Importantly, emotional responses to positive stimuli, including happiness, were comparable between patients and healthy controls. These results underscore the importance of evaluating basic emotions separately in depression research and highlight the potential value of targeting emotion-specific processes in treatment approaches.