Recognition of Facial Emotion Expressions in Patients with Depressive Disorders: A Functional MRI Study
, Merab Shariya 1,2, Alena Beliaevskaia 1,2, Ernesto Roldan-Valadez 2,3, Rodion Shishorin 2, Roman Akhapkin 4 and Beatrice Volel 2Round 1
Reviewer 1 Report
Ternovoy and colleagues present a study about the neuroimaging study about the emotion recognition deficits in major depressive disorder. Despite the author stated that the noverlty of current study is addressing whether the detected activation patterns in depressed patients are neurobiological abnormalities or markers of depression that can be corrected during treatment with antidepressants. However, to my personal view, several points still need to be further addressed.
1. The novelty: As the author stated that ‘more than 25 studies have been published that have evaluated the activation of the cerebral cortex in response to the demonstration of emotional faces in patients with depression’, under such context, what findings of current study will add should be clearly stated. The subjects with treatment I don’t think it is enough to address the inconsistency as the author stated ‘heterogeneity of patient samples (for example, according to the severity or clinical form of the disease), different paradigms for fMRI, and other neural models to interpret the imaging results’. It will be great to state the novelty clearly.
2. The display: The quality of the figures I should say quite bad, especically the brain image view. The author could work more a bit on the figures.
3. Discussions: The author should the potential meaning of the current findings, rather than just cite some papers. For example, the author should explain why prefrontal cortex engaged in emotion recognition. Otherwise, the discussion seems quite superficial. Moreover, the references of the author cited are quite old, The latest study is 2021. This paper if goes well, it will come out 2023, at least several papers published in 2022 should be cited. I would strongly suggest the author cite the latest three years’work instead.
4. Regarding to the data analysis, I would suggest the author could try to use more sophisticated methods, e.g., PPI or DCM, which would further add information about how the brain regions interaction under task context.
Author Response
Please see the attachment.
Author Response File: 
Author Response.docx
Reviewer 2 Report
Please list the statistical methods below the table, which calculated the p-value.
Please improve the resolution of figures.
Please define and give the examples of P+, N, N- facial emotions.
Please explain why in figure 2, there was missing for one panel.
He biggest problem is that the motivation of this work is not clear, what’s the new of this study compared the existed work.
Author Response
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Author Response File: Author Response.docx
Reviewer 3 Report
In the article entitled “Recognition of Facial Emotion Expressions in Patients with Depressive Disorders: A Functional MRI Study”, the authors evaluated cortical activation during emotional processing after eight weeks of antidepressant treatment using fMRI.
In healthy subjects, the following was found:
(1) More activation with neutral emotions – frontal cortex
(2) Less activation with positive and negative emotions – frontal cortex
(3) Overall activation – amygdala, insula, left superior temporal gyrus
(4) Overall deactivation – posterior cingulate cortex
In depressed subjects, the following was found:
(1) Overall activation – middle and inferior frontal gyri, fusiform gyrus, occipital cortex, left superior temporal gyrus
(2) Less activation with negative emotions – frontal cortex
The study concluded that abnormalities in the processing of emotional stimuli can be a sign of depressive disorder.
Major concerns: Although the article is well-written and easy to follow, the serious and major limitation of the study is that the sample size is very small. There are only 16 subjects per group, with as low as 2 and 3 male subjects in the patients and control groups. Therefore, the statistical power is very low to conclude from the study. In agreement with this, line 202 states, “The difference of cortical activation areas in the patient and control group did not exceed the statistical significance threshold.” Thus, it is evident that the study is underpowered statistically. Hence the conclusion drawn from this study is not robust and cannot be relied upon confidently.
Other minor concerns are as follows:
a) fMRI was done twice in the patient's group and once in controls. The reason for this is not clear.
b) “Several studies reported an increase in limbic activity in individuals with depression compared to the control group [10], while others did not find similar differences [12].” Although “several” and “others” are mentioned in the sentence, only one reference is given for each.
c) “In this study, we thought to evaluate…” – A better way of expressing this might be to state the hypothesis of the study.
d) “age of 37.3±9.7” – please mention “years”
e) Line 149: Please replace “you can find” in the third person, or like “can be found”.
f) In conclusion it is mentioned as “left superior parietal gyrus”, while in results and discussion sections, it is mentioned as “left superior temporal gyrus”.
Author Response
Please see the attachment.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
No further comments will be provided.
Reviewer 2 Report
The authors have given comprehensive response to the reviewer and the reviewer agreed to accept it.
Reviewer 3 Report
The authors addressed my comments. Minor English editing is required throughout the manuscript. I have no further comments. Thank you.
