CoChat
Sign Up
Cited by 113Treatment of Major DepressionNeural and Behavioral Psychology StudiesAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Computational mechanisms of effort and reward decisions in patients with depression and their association with relapse after antidepressant discontinuation.

Open access
Berwian, Isabel M., Wenzel, Julia G., Collins, Anne G. E., Seifritz, Erich, Stephan, Klaas E., Walter, Henrik, Huys, Quentin J. M.·2020·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2019.4971PMC PMC7042923
Open this paper in CoChat — free accountOpen PDF

Abstract

Importance: Nearly 1 in 3 patients with major depressive disorder who respond to antidepressants relapse within 6 months of treatment discontinuation. No predictors of relapse exist to guide clinical decision-making in this scenario. Objectives: To establish whether the decision to invest effort for rewards represents a persistent depression process after remission, predicts relapse after remission, and is affected by antidepressant discontinuation. Design, Setting, and Participants: This longitudinal randomized observational prognostic study in a Swiss and German university setting collected data from July 1, 2015, to January 31, 2019, from 66 healthy controls and 123 patients in remission from major depressive disorder in response to antidepressants prior to and after discontinuation. Study recruitment took place until January 2018. Exposure: Discontinuation of antidepressants. Main Outcomes and Measures: Relapse during the 6 months after discontinuation. Choice and decision times on a task requiring participants to choose how much effort to exert for various amounts of reward and the mechanisms identified through parameters of a computational model. Results: A total of 123 patients (mean [SD] age, 34.5 [11.2] years; 94 women [76%]) and 66 healthy controls (mean [SD] age, 34.6 [11.0] years; 49 women [74%]) were recruited. In the main subsample, mean (SD) decision times were slower for patients (n = 74) compared with controls (n = 34) (1.77 [0.38] seconds vs 1.61 [0.37] seconds; Cohen d = 0.52; P = .02), particularly for those who later relapsed after discontinuation of antidepressants (n = 21) compared with those who did not relapse (n = 39) (1.95 [0.40] seconds vs 1.67 [0.34] seconds; Cohen d = 0.77; P < .001). This slower decision time predicted relapse (accuracy = 0.66; P = .007). Patients invested less effort than healthy controls for rewards (F1,98 = 33.970; P < .001). Computational modeling identified a mean (SD) deviation from standard drift-diffusion models that was more prominent for patients than controls (patients, 0.67 [1.56]; controls, -0.71 [1.93]; Cohen d = 0.82; P < .001). Patients also showed higher mean (SD) effort sensitivity than controls (patients, 0.31 [0.92]; controls, -0.08 [1.03]; Cohen d = 0.51; P = .05). Relapsers differed from nonrelapsers in terms of the evidence required to make a decision for the low-effort choice (mean [SD]: relapsers, 1.36 [0.35]; nonrelapsers, 1.17 [0.26]; Cohen d = 0.65; P = .02). Group differences generally did not reach significance in the smaller replication sample (27 patients and 21 controls), but decision time prediction models from the main sample generalized to the replication sample (validation accuracy = 0.71; P = .03). Conclusions and Relevance: This study found that the decision to invest effort was associated with prospective relapse risk after antidepressant discontinuation and may represent a persistent disease process in asymptomatic remitted major depressive disorder. Markers based on effort-related decision-making could potentially inform clinical decisions associated with antidepressant discontinuation.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2019.4971

Cites

50 of 50 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A behavioral measure based on effort sensitivity, assessed at baseline, was predictive of relapse.

    “and a behavioral measure based on effort sensi vity, assessed at baseline, was predic ve of relapse, although it was not altered by the discon nua on itself [14].”

    From Amygdala Reactivity, Antidepressant Discontinuation, and Relapse (2024) · cites this paper as [14]

    The Prediction section reports that baseline decision time on an effort-for-reward task predicted relapse (balanced accuracy 0.66). The paper does not identify effort sensitivity itself as the predictive measure; its reported predictor was decision time. The Follow-up Procedure describes the baseline assessment as preceding discontinuation (page numbers unavailable in our copy). (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Cognitive measures, such as behavioural assessments of effort-sensitivity, have been found to be predictive of relapse after antidepressant discontinuation.

    “Cogni ve measures, such as behavioural assessments of effort-sensi vity, have recently been found to be predic ve of relapse a er ADM discon nua on [14], with evidence emerging also for EEG [15] and possibly res ng-state fMRI measures [16].”

    From Amygdala Reactivity, Antidepressant Discontinuation, and Relapse (2024) · cites this paper as [14]

  • The behavioral measure based on effort sensitivity was not altered by antidepressant discontinuation itself.

    “and a behavioral measure based on effort sensi vity, assessed at baseline, was predic ve of relapse, although it was not altered by the discon nua on itself [14].”

    From Amygdala Reactivity, Antidepressant Discontinuation, and Relapse (2024) · cites this paper as [14]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. [3]3. National Institute for Health and Clinical Excellence. Guidance: Depression: The Treatment and Management of Depression in Adults (Updated Edition). Leicester, UK: British Psychological Society; 2010.

Cited by

Sorted by citations

Related

Authors
Berwian, I. M., Wenzel, J. G., Collins, A. G. E., Seifritz, E., Stephan, K. E., Walter, H., & Huys, Q. J. M.
Affiliations
  • University of Zurich (CH)
  • Charité – Universitätsmedizin Berlin (DE)
  • University of California, Berkeley (US)
  • Wellcome Centre for Human Neuroimaging (GB)
Corresponding author
Berwian, Isabel M.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2020-05-01
Volume
77
Issue
5
Pages
513
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2019.4971
PMC
PMC7042923
OpenAlex
W3007506865
Cited by
113
References
50
Citations by year
2026: 16 · 2025: 13 · 2024: 24 · 2023: 17 · 2022: 17 · 2021: 22 · 2020: 4
FWCI
9.00
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • MPG.PuRe (Max Planck Society) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
Funders
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
major depressive disorder, recurrence prediction, antidepressant discontinuation, computational modeling, drift-diffusion model, decision time, effort investment, remission, treatment-resistant depression, reward processing, impulsivity, reward delay
MeSH terms
Adult, Antidepressive Agents, Decision Making, Major Depressive Disorder, Physical Exertion, Female, Humans, Longitudinal Studies, Male, Reaction Time, Recurrence, Reward, Models, Statistical, Case-Control Studies, Withholding Treatment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review