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Researchers at NYU Langone Health have created a mobile game designed to detect signs of major depressive disorder with remarkable speed, identifying potential indicators in as little as three minutes. The study, published in the Proceedings of the National Academy of Sciences, focuses on how long individuals persist when faced with shrinking rewards.

The game involves players collecting apples from digital trees. As each round progresses, the yield from a tree decreases. The software precisely records the moment a player decides the diminishing harvest is no longer worthwhile and switches to a new tree. This switch-over point serves as the key metric for researchers.

In a study involving 120 participants, 50 diagnosed with major depression and 70 without, those with depression abandoned the fading reward approximately 50% sooner than healthy individuals. Typically, healthy players continued until a tree yielded around five apples, whereas depressed players disengaged much earlier, often when a tree still offered eight or nine apples, depending on symptom severity.

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Patients with depression do not seem to be able to adapt their expectations normally as conditions change, which gives us a hint about what is wrong mechanistically in their brains.

This task is designed to measure anhedonia, a pervasive symptom affecting roughly 70% of individuals with major depression, characterized by a loss of pleasure. The researchers theorize that depression alters the brain's internal benchmark for what constitutes a rewarding experience, causing normally pleasurable stimuli to feel flat or even negative. The game leverages a known link between anhedonia and the anterior cingulate cortex, a brain region crucial for setting expectations.

Further research involved participants bidding on snack foods. While healthy individuals showed a temporary shift in perceived value when bidding on favorite snacks versus a mixed list, their sense of value normalized quickly. In contrast, depressed patients exhibited a persistent shift in their sense of value that did not recover. "Patients with depression do not seem to be able to adapt their expectations normally as conditions change, which gives us a hint about what is wrong mechanistically in their brains," stated co-first author Aadith Vittala. The team is exploring whether behavioral therapy or medication can address this "reference point stickiness."

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Our behavioural game gives us clues to what is happening in the brains of patients with depression, which we hope will let us identify them as reliably as finding heart disease by taking someone's blood pressure.