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Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: A meta-analysis and review.
Open accessAbstract
Cognitive impairments are now widely acknowledged as an important aspect of major depressive disorder (MDD), and it has been proposed that executive function (EF) may be particularly impaired in patients with MDD. However, the existence and nature of EF impairments associated with depression remain strongly debated. Although many studies have found significant deficits associated with MDD on neuropsychological measures of EF, others have not, potentially due to low statistical power, task impurity, and diverse patient samples, and there have been no recent, comprehensive, meta-analyses investigating EF in patients with MDD. The current meta-analysis uses random-effects models to synthesize 113 previous research studies that compared participants with MDD to healthy control participants on at least one neuropsychological measure of EF. Results of the meta-analysis demonstrate that MDD is reliably associated with impaired performance on neuropsychological measures of EF, with effect sizes ranging from 0.32 to 0.97. Although patients with MDD also have slower processing speed, motor slowing alone cannot account for these results. In addition, some evidence suggests that deficits on neuropsychological measures of EF are greater in patients with more severe current depression symptoms, and those taking psychotropic medications, whereas evidence for effects of age was weaker. The results are consistent with the theory that MDD is associated with broad impairment in multiple aspects of EF. Implications for treatment of MDD and theories of EF are discussed. Future research is needed to establish the specificity and causal link between MDD and EF impairments.
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In the citing paper
“though most of the literature has generally found non-significant relationships9,34,58,59.”
From Diagnostic Associations of Processing Speed in a Transdiagnostic, Pediatric Sample (2020) · cites this paper as [58]
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Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Additionally, a recent meta-analysis noted that individuals with MDD exhibit non-specific cognitive deficits related to difficulty planning and slower processing speed (Snyder, 2013).”
From Lisdexamfetamine Dimesylate Augmentation in Adults With Persistent Executive Dysfunction After Partial or Full Remission of Major Depressive Disorder (2014) · cites this paper as Snyder, 2013
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Both publications suggest that MDD is associated with deficits across a wide range of cognitive domains”
From Cognitive Effects of Pharmacotherapy for Major Depressive Disorder: A Systematic Review (2014) · cites this paper as [59]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“cognitive impairment may correlate with depressive symptom severity on some measures”
From Cognitive Effects of Pharmacotherapy for Major Depressive Disorder: A Systematic Review (2014) · cites this paper as [59]
The cited source says what the claim attributes to it.
In the citing paper
“the categorization of neurocognitive tests offered in the meta-analysis sometimes differed from our own, again indicating the need for greater understanding of and consensus on the various domains of cognition”
From Cognitive Effects of Pharmacotherapy for Major Depressive Disorder: A Systematic Review (2014) · cites this paper as [59]
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In the citing paper
“impairments may persist despite remission of depressive symptoms.”
From Cognitive Effects of Pharmacotherapy for Major Depressive Disorder: A Systematic Review (2014) · cites this paper as [59]
In the citing paper
“Recurrently depressed individuals’ vulnerability to depressogenic cognition is additionally exacerbated by impaired cognitive functioning and diminished cognitive resources.”
From Mindfulness-Based Interventions in Psychiatry (2018) · cites this paper as [66]
In the citing paper
“These individuals often exhibit overgeneral autobiographical memory (i.e. a difficulty in retrieving specific personal events), impairments in attention regulation, and difficulties suppressing competing or currently-irrelevant thoughts and mental sets, among other cognitive deficits (62–68).”
From Mindfulness-Based Interventions in Psychiatry (2018) · cites this paper as [66]
In the citing paper
“similar effect sizes and somewhat similar heterogeneity trends were recently identified across DSM disorders (15–18)”
From Neuropsychological Research in Obsessive-Compulsive Disorder: Current Status and Future Directions (2021) · cites this paper as [15]
In the citing paper
“A meta-analysis of 113 studies found significant deficits in executive functioning among depressed individuals compared to non-depressed controls, including deficits in updating, shifting, inhibition, working memory, planning, and verbal fluency, with effect sizes ranging from d = 0.32 – 0.97 (Snyder, 2014).”
From The role of inflammation in core features of depression: Insights from paradigms using exogenously-induced inflammation. (2018) · cites this paper as Snyder, 2014
In the citing paper
“Deficits purported to fall within the domain of EF have commonly been found in individuals with depression using neuropsychological tests (Channon et al. 1993; Gohier, et al. 2009; Porter et al. 2003; Purcell et al. 1997; for a review see, Snyder 2013), other behavioral tasks (Joormann and Gotlib 2008; Rose and Ebmeier 2006), and self-report measures (Warren, Heller, and Miller, under review).”
From Executive Function Deficits in Daily Life Prospectively Predict Increases in Depressive Symptoms (2014) · cites this paper as Snyder 2013
In the citing paper
“Finally, MDD is characterized by broad impairments in cognitive control, which often persist following remission (Snyder, 2013) and exhibit trait-like stability (Sarapas et al, 2012).”
From Neural Correlates of Three Promising Endophenotypes of Depression: Evidence from the EMBARC Study (2016) · cites this paper as Snyder, 2013
In the citing paper
“For example, a recent meta-analysis indicates that clinical depression is associated with impairment across multiple executive functions, including inhibitory control, shifting, and updating working memory (Snyder, 2013).”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Snyder, 2013
In the citing paper
“Notwithstanding these limitations, separate meta-analyses provide compelling evidence that (objective) cognitive impairment is a consistent, replicable, non-specific, and clinically significant feature of MDD – and, for that matter, many major psychiatric disorders [10, 14, 33–35].”
From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [34]
In the citing paper
“In keeping with the view that broad-based cognitive deficits are associated with MDD, the presence of significant deficits in executive functions and psychomotor speed in adults with MDD has been confirmed by a separate meta-analysis of 113 studies (Cohen’s d effect sizes ranging from −0.32 to −0.97) [34].”
From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [34]
In the citing paper
“Cognitive assessment was completed using a variant of the n-back task, a task which has shown sensitivity to impairments in MDD [35].”
From Wearable technology for high-frequency cognitive and mood assessment in major depressive disorder: longitudinal observational study (2019) · cites this paper as [35]
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Metadata
- Authors
- Snyder, H. R.
- Affiliations
- University of Colorado Boulder (US)
- Corresponding author
- Snyder, Hannah R.
- ORCID
- Snyder, Hannah R.
- Venue
- Psychological Bulletin
- Published
- 2013
- Volume
- 139
- Issue
- 1
- Pages
- 81-132
- ISSN
- 0033-2909 (ISSN-L)
- 1939-1455
- PMC
- PMC3436964
- OpenAlex
- W2093220018
- Cited by
- 1,667
- References
- 324
- Citations by year
- 2026: 132 · 2025: 146 · 2024: 111 · 2023: 124 · 2022: 144 · 2021: 175 · 2020: 140 · 2019: 123 · 2018: 150 · 2017: 137 · 2016: 107 · 2015: 91 · 2014: 53 · 2013: 25
- FWCI
- 28.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Bulletin (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (F31-MH087073)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, executive function, cognitive impairment in depression, neuropsychological measures, processing speed, motor slowing, depression severity, age effects, depression treatment
- MeSH terms
- Cognition Disorders, Major Depressive Disorder, Humans, Neuropsychological Tests, Executive Function
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