Cognitive impairment in the remitted state of unipolar depressive disorder: A systematic review
Abstract
Background It is unclear whether cognitive impairment is prevalent in the remitted state of unipolar disorder.Aim To evaluate whether cognitive function is impaired in the remitted state in patients with unipolar depression compared with healthy control individuals, and to investigate the association to prior course of illness, i.e. the number, duration and severity of prior depressive episodes.Method Systematic search on existing on-line databases and hand-search of original published papers.Results A total of 11 studies fulfilled the selection criteria and were included in the review, including a total of 500 patients remitted from unipolar depression and 471 healthy control individuals. In nine of the eleven studies performance on neuropsychological tests was found to be decreased in patients compared to healthy control individuals in at least one of the tests. Methodological drawbacks were prevalent including non-stringent definition of remission and non-correction for multiple testing. Only few studies investigated the association between cognition and prior course of illness and the results were divergent.Limitations Stringent criteria were used in the assessment of eligibility of studies. The studies were first and foremost selected according to the criteria for remission used.Conclusion Cognitive dysfunction seems to be present in individuals suffering from unipolar disorder in the remitted state. We recommend that future studies should focus on disentangling the state and trait characteristics of cognitive dysfunction in unipolar disorder and further clarify the associations with clinical phenotype, course of illness and subsyndromal psychopathology. Furthermore, there is a need to identify the cognitive difficulties in individuals suffering from unipolar disorder in relation to psychosocial function, quality of life and risk of recurrence and to assess the effect of treatment intervention on cognitive function.
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Neurocognitive dysfunction is commonly reported during depressive episodes and even during remission.
“Neurocognitive dysfunction is commonly reported during depressive episodes and even during remission (Bora et al., 2013;Conradi et al., 2011;Hasselbalch et al., 2011).”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Hasselbalch et al., 2011
Cognitive dysfunction is a core symptom of depression that can persist during the remitted state, worsens with increasing numbers of depressive episodes, and results in disrupted psychosocial functioning.
“As cognitive dysfunction is a core symptom of depression that can persist during the remitted state (Bora et al., 2013;Hasselbalch et al., 2011;Kaser et al., 2017), worsens with increasing numbers of depressive episodes (Hasselbalch et al., 2013), and results in disrupted psychosocial functioning (Hasselbalch et al., 2011;Kaser et al., 2017;McCall and Dunn, 2003)”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Hasselbalch et al., 2011
A systematic review of 11 studies involving 500 adult patients in remission from major depressive disorder documented persistent deficits in sustained and selective attention, memory, and executive function, but heterogeneity prevented estimation of precise effect sizes.
“For example, a systematic review of 11 studies involving 500 adult patients in remission from MDD documented persistent deficits in sustained and selective attention, memory, and executive function. However, the heterogeneity across studies did not allow for the estimation of precise effect sizes [37].”
From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [37]
Cognitive symptoms persist beyond the symptoms of low mood.
“Cognitive symptoms are seen in first-episode depression [6,8], persist beyond the symptoms of low mood [9-11], contribute to the risk of relapse [12], and worsen with repeated depressive episodes [13,14].”
From Wearable technology for high-frequency cognitive and mood assessment in major depressive disorder: longitudinal observational study (2019) · cites this paper as [9]
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Mac Giollabhui, N., Olino, T. M., Nielsen, J., Abramson, L. Y., & Alloy, L. B. (2019) · Clinical Psychological Science · doi:10.1177/2167702618794920 · Cited by 29 · see citing works
Dealing with heterogeneity of cognitive dysfunction in acute depression: A clustering approach
Vicent-Gil, M., Portella, M. J., Serra-Blasco, M., Navarra-Ventura, G., Crivillés, S., Aguilar, E., Palao, D., & Cardoner, N. (2021) · Psychological Medicine · doi:10.1017/s0033291720001567 · Cited by 28 · see citing works
Mac Giollabhui, N., Alloy, L. B., Schweren, L. J. S., & Hartman, C. A. (2021) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2021.05.022 · Cited by 25 · see citing works
Mikoteit, T., Hemmeter, U., Eckert, A., Brand, S., Bischof, R., Delini-Stula, A., Holsboer-Trachsler, E., & Beck, J. (2015) · Neuropsychobiology · doi:10.1159/000437439 · Cited by 25 · see citing works
Functional cognitive disorders: identification and management
Poole, N. A., Cope, S. R., Bailey, C., & Isaacs, J. D. (2019) · BJPsych Advances · doi:10.1192/bja.2019.38 · Cited by 15 · see citing works
Hutnyan, M., & McClintock, S. M. (2025) · Transcranial Magnetic Stimulation · doi:10.1016/j.transm.2025.100088 · Cited by 2 · see citing works
- Authors
- Hasselbalch, B. J., Knorr, U., & Kessing, L. V.
- Affiliations
- Copenhagen University Hospital (DK)
- Rigshospitalet (DK)
- Corresponding author
- Hasselbalch, Bo Jacob
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2011-11
- Volume
- 134
- Issue
- 1-3
- Pages
- 20-31
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2103000760
- Semantic Scholar
- 2a03666c0675cf10ad2929a42c331d0981bc8bee
- Cited by
- 406
- References
- 52
- Citations by year
- 2026: 13 · 2025: 21 · 2024: 16 · 2023: 21 · 2022: 30 · 2021: 26 · 2020: 37 · 2019: 40 · 2018: 39 · 2017: 21 · 2016: 36 · 2015: 40 · 2014: 21 · 2013: 20 · 2012: 19
- FWCI
- 1.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Funders
- Pfizer
- AstraZeneca
- Lundbeckfonden (R17-2007-1798)
- H. Lundbeck A/S
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- cognitive impairment, major depressive disorder, remission, clinical course, neuropsychological performance, recurrence risk
- MeSH terms
- Cognition Disorders, Depression, Depressive Disorder, Humans, Neuropsychological Tests, Recurrence, Case-Control Studies
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