Mechanisms of Behavioral Activation (BA)

The primary aim of this study is to investigate the behavioral and neurobiological factors predicting response to Behavior Activation (BA), a psychosocial treatment for Major Depressive Disorder (MDD), in adolescents.

The recruitment age pool will be adolescents ages 15-17. The investigators plan to recruit 40 healthy controls and 96 treatment-seeking adolescents for an overall sample of ~136 participants, Individuals who reach the age of majority (18) during the study will be re-consented as adults and allowed to continue participating in the study.

A healthy control group will be included to assess stability in behavioral and neuroimaging measures over the course of participation in the study.

The fMRI scan schedule will include three task-based sessions (baseline, after session 7, and after endpoint) and two (sessions 3 & 9). "behavioral-scheduling-in-the-scanner" sessions Primary results will focus on symptom change within patients and their association to measures of low motivation and threat avoidance.

Inclusion criteria

• Male and female adolescents ages 15-17;
• current MDD diagnosis as determined by K-SADS-PL,
• CDRS-R raw score > 45 (T-score > 65) at baseline;
• estimated full scale IQ > 80 as determined by the WASI-II;
• able to receive outpatient care;
• willing to not partake in other psychosocial treatments;
• not taking psychotropic medications in the two weeks (four weeks for fluoxetine) prior to consent, with the exception of psychostimulant medication prescribed for the treatment of ADHD.
• Additionally, depressed patients must have access to required technology (e.g. smart phone, tablet, or desktop computer) to complete the EMA portion of the study.
• Healthy controls cannot not meet criteria for MDD and their CDRS-R raw score must be below 28; T-score < 52).

Exclusion criteria

• Current or past diagnosis of bipolar, schizophrenia, schizophreniform, schizoaffective disorders, or psychosis NOS;
• current diagnosis of developmental disorder, severe conduct disorder, life-threatening anorexia, OCD, or autism-spectrum disorders;
• taking psychotropic medications prior to entry;
• estimated IQ < 80; alcohol/drug dependence or abuse within the last 3 months;
• potential/confirmed neurological disorder or epilepsy;
• claustrophobia;
• presence of a medical condition that precludes fMRI;
• endorsement of imminent and serious suicidality;
• medical conditions that take precedence over the presence of MDD;
• pregnancy;
• substance use (excluding nicotine) within two weeks of the fMRI scan;
• left-handedness;
• nicotine use within 3 hours of the fMRI scan;
• history of traumatic brain injury or of being unconscious for more than 30 minutes;
• a stimulant regime for ADHD which has changed within 30 days of the fMRI scan.
• Non-compliance (i.e. <70% completion) or inability (i.e. lack of smartphone device) to complete the 3 assessment periods of EMA.