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The Importance of Assessing Neural Trajectories in Pediatric Depression.

In this issue of JAMA Psychiatry, Luby et al1 report neuroimagingfindings fromalongitudinal studyof193youthswhowere carefully assessed for clinical depression since preschool and underwent neuroimagingmultiple timesduring early adolescence. Using growth curve modeling, Luby and colleagues characterized trajectories of cortical structure as a functionofdepression.They foundthatglobalvolumeofgray matter, indexed by cortical thickness, declined more steeply inadolescentswithmore severedepression.Given that theage rangemodeled here is characterized by a decrease in volume of graymatter that is posited to reflect synaptic pruning, this finding suggests that synaptic pruning is particularly aggressive in individuals who have experienced symptoms of depression. The research presented by Luby et al highlights the types of clinical questions that can be addressed through longitudinal neuroimaging research. We describe 3 specific ways in which such research can informourunderstanding of psychiatric disorders: by revealing variability in etiologic pathways to disorder, by elucidating how external influences can alter neural trajectories and thereby either contribute to psychiatric disorders or counteract maladaptive developmental processes, and by clarifying critical changes during specific sensitive developmental periods.