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Kathleen M. Thomas, PhD; Wayne C. Drevets, MD; Ronald E. Dahl, MD; Neal D. Ryan, MD; Boris Birmaher, MD; Clayton H. Eccard; David Axelson, MD; Paul J. Whalen, PhD; B. J. Casey, PhD

Arch Gen Psychiatry. 2001;58:1057-1063.

Background  Alterations in amygdala function have been implicated in the pathophysiological characteristics of adult anxiety and depressive disorders. Studies with healthy adults and children, as well as with adults who have amygdala lesions, have found facial expressions of emotion to be useful probes of amygdala activity. Our study examined the amygdala response to fearful and neutral facial expressions in healthy, anxious, and depressed children. We hypothesized that children with anxiety and depression may show atypical amygdala responses to emotional stimuli.

Methods  Twelve children (8-16 years of age) with generalized anxiety or panic disorder and 12 healthy comparison children underwent noninvasive functional magnetic resonance imaging while viewing photographs of fearful and neutral facial expressions. In a second comparison, 5 girls with major depressive disorder were compared with 5 anxious and 5 healthy girls from the previous sample.

Results  Children with anxiety disorders showed an exaggerated amygdala response to fearful faces compared with healthy children, whereas depressed children showed a blunted amygdala response to these faces. In addition, the magnitude of the amygdala's signal change between fearful and neutral faces was positively correlated with the severity of everyday anxiety symptoms.

Conclusions  Our results suggest that amygdala function is affected in both anxiety and depression during childhood and adolescence. Moreover, this disruption appears to be specific to the child's own rating of everyday anxiety.

From the Sackler Institute for Developmental Psychobiology, Department of Psychiatry, Weill Medical College of Cornell University, New York, NY (Drs Thomas and Casey and Mr Eccard); the Mood and Anxiety Disorders Neuroimaging Section, National Institute of Mental Health, Bethesda, Md (Dr Drevets); the Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pa (Drs Drevets, Dahl, Ryan, Birmaher, and Axelson); and the Departments of Psychiatry and Psychology, University of Wisconsin, Madison (Dr Whalen).

Corresponding author and reprints: Kathleen M. Thomas, PhD, Sackler Institute for Developmental Psychobiology, Weill Medical College of Cornell University, 1300 York Ave, Box 140, Suite F-1332, New York, NY 10021 (e-mail: kmt2001{at}med.cornell.edu).

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