Depression and Reward Function in Adolescence and the Potential of Behavioural Activation as a Treatment: A Narrative Review

Depression in adolescence is associated with poorer outcomes than adult-onset depression. While effective treatment can prevent difficulties from persisting into adulthood, current interventions for adolescent depression are often limited in effectiveness, likely because they fail to address the specific mechanisms underlying depression during this developmental stage. Access to treatment for adolescents presents an additional challenge. Effective, practical, and targeted treatments are urgently needed. To achieve this, we must identify key mechanisms of adolescent depression and develop interventions that address them directly.Growing evidence highlights reward function as a key mechanism in adolescent depression. At the same time, research suggests that Behavioural Activation (BA), with its emphasis on reward-focused behavioural changes, may be an effective treatment for adolescents with depression. To integrate these lines of research, we used a narrative approach to synthesise cross-disciplinary literature on reward function and BA in adolescent depression.This review found encouraging evidence for the effectiveness, feasibility, and cost-effectiveness of BA in adolescents. BA also shows potential for those with co-occurring autism or anxiety. However, the mechanisms through which BA works in adolescence are still unknown, and questions remain on its optimal delivery. Further research is needed to clarify how reward function influences both adolescent depression and response to BA, as well as how adolescents themselves wish to engage with BA therapy.