{
  "abstract": "Negative emotional bias, including reduced processing of positive information and negative interpretation of ambiguous stimuli, is a core feature of depression. Esketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist with rapid antidepressant effects in treatment-resistant depression (TRD), reduces depressive symptoms, but its effects on distinct components of emotional processing remain unclear. Fifty-three patients with TRD and 53 healthy controls performed an Emotional Facial Expression Morphing task. Patients were assessed at baseline, 24 hours after the first esketamine administration, and after 4 weeks of treatment. Statistical models examined detection thresholds for happy and sad faces, negative categorisation of neutral faces, and signal detection indices separating emotion-neutral discrimination sensitivity (d') from response criterion (c), indexing the evidence required to report the presence of an emotion. At baseline, patients required greater happy-face intensity for emotion detection and were more likely to categorise detected neutral faces as negative. They also showed a more conservative response criterion without group difference in discrimination sensitivity. Responders showed an early increase in d' and, by week 4, less negative categorisation of neutral faces than non-responders. A lower baseline response criterion was associated with responder status and, in secondary continuous analyses, with greater subsequent MADRS improvement. These findings indicate that TRD involves abnormalities across detection-related, valence-related, and decisional aspects of facial-emotion processing that are differently associated with esketamine response: baseline response criterion emerged as a candidate prognostic marker, whereas negative categorisation of neutral faces tracked clinical response. Assessing these domains may inform clinical evaluation, pending independent replication.",
  "abstract_shown": true,
  "affiliations": [
    "Institut Pasteur, CNRS UMR 3571, Perception and Action Unit, F-75015 Paris, France"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "C. Muh"
    },
    {
      "name": "P. Favre"
    },
    {
      "name": "I. K. Lutkenherm"
    },
    {
      "name": "J. Zambrano"
    },
    {
      "name": "C. Henry"
    },
    {
      "name": "L. Berkovitch"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ajb510etzxrbd.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.14.26365535",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.14.26365535v1.full",
  "id": "ajb510etzxrbd",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.14.26365535v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "psychiatry and clinical psychology"
    ],
    [
      "openalex",
      "2736|Treatment of Major Depression"
    ]
  ],
  "openalex": "W7222003466",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.14.26365535v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-14",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/ajb510etzxrbd.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:58Z",
      "native_id": "10.64898/2026.10.14.26365535",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.14.26365535v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:psychiatry and clinical psychology",
      "subfield": "psychiatry"
    }
  ],
  "title": "Baseline Response Criterion and Changes in Emotional Bias as Markers of Esketamine Response in Treatment-Resistant Depression",
  "title_text": "Baseline Response Criterion and Changes in Emotional Bias as Markers of Esketamine Response in Treatment-Resistant Depression",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:58Z",
  "url": "https://research.draconitic.com/paper/ajb510etzxrbd",
  "venue": "medRxiv",
  "versions": []
}