Impaired flexible decision-making in major depressive disorder
Abstract
Background Depression is associated with dysfunctional affective states, neuropsychological impairment and altered sensitivity to reward and punishment. These impairments can influence complex decision-making in changing environments.Methods The contingency shifting variant Iowa Gambling Task (IGT) was used to assess flexible decision-making performance in a group of medicated unipolar Major Depressive Disorder (MDD) patients (n=19) and a group of healthy control volunteers (n=20). The task comprised the standard IGT followed by a contingency-shift phase where decks progressively changed reward and punishment schedule.Results Patients with MDD showed impaired performance compared to controls during both the standard and the contingency-shift phases of the IGT. Analysis of the contingency-shift phase demonstrated that individuals with depression had difficulties perceiving when a previously bad contingency became good.Limitations The present findings have several limitations including small sample size, the possible confounding role of medication and absence of other neuropsychological tests (i.e., executive function).Conclusion Depressed patients show impaired decision-making behaviour in static and dynamic environments. Altered sensitivity to reward and punishment is proposed as the mechanism responsible for the lack of advantageous choices and poor adjustment to a changing environment.
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Decision-making and learning impairments are core characteristics of a wide range of psychiatric disorders, including MDD, OCD, and schizophrenia, and are linked to their specific symptoms.
“Decision-making and learning impairments are core characteristics of a wide range of psychiatric disorders — such as major depressive disorder (MDD), obsessive–compulsive disorder (OCD), and schizophrenia — and are linked to their specific symptoms.1–9”
From Investigating disorder-specific and transdiagnostic alterations in model-based and model-free decision-making (2024) · cites this paper as [4]
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- Authors
- Cella, M., Dymond, S., & Cooper, A.
- Affiliations
- King's College London (GB)
- Swansea University (GB)
- Goldsmiths University of London (GB)
- Corresponding author
- Cella, Matteo
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2010-07
- Volume
- 124
- Issue
- 1-2
- Pages
- 207-210
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2053184662
- Cited by
- 192
- References
- 17
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 9 · 2023: 8 · 2022: 12 · 2021: 12 · 2020: 23 · 2019: 11 · 2018: 11 · 2017: 12 · 2016: 19 · 2015: 12 · 2014: 12 · 2013: 14 · 2012: 18
- FWCI
- 4.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, decision-making flexibility, Iowa Gambling Task, reward sensitivity, punishment sensitivity, dynamic environments, antidepressants, neuropsychological deficits
- MeSH terms
- Adult, Antidepressive Agents, Attention, Cognition Disorders, Decision Making, Major Depressive Disorder, Drug Therapy, Combination, Female, Gambling, Humans, Male, Middle Aged, Neuropsychological Tests, Psychometrics, Punishment, Reference Values, Reward, Lithium Carbonate
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