Uniformity in happiness and uniqueness in sadness: Naturalistic emotional representation in major depression

Humans develop shared concepts of others' emotions to support adaptive social functioning, yet how these concepts are dynamically represented in major depressive disorder (MDD) during naturalistic movie viewing is not yet fully established. Using functional MRI, we examined patients with MDD (n = 55) and healthy controls (HCs; n = 62) as they freely viewed movie clips depicting happy and sad emotions. Neural similarity was quantified with inter-subject correlation at whole-brain, network, and regional levels, and its association with emotional traits was assessed using inter-subject representational similarity analysis. Compared with HCs, patients with MDD showed significantly reduced whole-brain similarity, particularly during sad contexts. Network analyses revealed that HCs exhibited increased similarity in the limbic network during sadness, reflecting a shared "sadness resonance," whereas patients with higher depressive severity showed widespread disruptions across visual, limbic, dorsal attention, and default mode networks. At the regional level, similarity in the inferior temporal gyrus and lateral occipital cortex was closely linked to individual differences in emotional awareness, with pronounced context- and region-specificity. These findings highlight neural decoupling and heterogeneity as core features of MDD and provide new evidence for potential biomarkers to inform risk assessment and personalized interventions.