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Cited by 329Neural and Behavioral Psychology StudiesTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Paying attention to attention in depression

Open access
Keller, Arielle S., Leikauf, John E., Holt-Gosselin, Bailey, Staveland, Brooke R., Williams, Leanne M.·2019·Translational Psychiatry
DOI 10.1038/s41398-019-0616-1PMC PMC6838308
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Abstract

Attention is the gate through which sensory information enters our conscious experiences. Oftentimes, patients with major depressive disorder (MDD) complain of concentration difficulties that negatively impact their day-to-day function, and these attention problems are not alleviated by current first-line treatments. In spite of attention’s influence on many aspects of cognitive and emotional functioning, and the inclusion of concentration difficulties in the diagnostic criteria for MDD, the focus of depression as a disease is typically on mood features, with attentional features considered less of an imperative for investigation. Here, we summarize the breadth and depth of findings from the cognitive neurosciences regarding the neural mechanisms supporting goal-directed attention in order to better understand how these might go awry in depression. First, we characterize behavioral impairments in selective, sustained, and divided attention in depressed individuals. We then discuss interactions between goal-directed attention and other aspects of cognition (cognitive control, perception, and decision-making) and emotional functioning (negative biases, internally-focused attention, and interactions of mood and attention). We then review evidence for neurobiological mechanisms supporting attention, including the organization of large-scale neural networks and electrophysiological synchrony. Finally, we discuss the failure of current first-line treatments to alleviate attention impairments in MDD and review evidence for more targeted pharmacological, brain stimulation, and behavioral interventions. By synthesizing findings across disciplines and delineating avenues for future research, we aim to provide a clearer outline of how attention impairments may arise in the context of MDD and how, mechanistically, they may negatively impact daily functioning across various domains.

AI snapshot

Written from the paper’s full text.

TL;DR

This review synthesizes cognitive neuroscience evidence on goal-directed attention impairments in major depressive disorder (MDD), covering selective, sustained, and divided attention, their neural and electrophysiological correlates, and treatment implications. It argues that attention deficits are clinically important, often persist despite first-line antidepressant treatment, and require more targeted, mechanism-informed interventions.

Key findings

  • Unmedicated depressed individuals show worse feature-based selective attention on color-word tasks, including in an international sample of n = 1008 MDD participants without comorbid ADHD, whereas spatial selective attention on Flanker tasks often does not differ from healthy controls.
  • Sustained attention is sometimes impaired in MDD (slower oddball responses), and divided attention impairments are linked to delayed response, increased relapse risk, and higher suicidality.
  • Attention depends on a fronto-parietal attention/control network; hypoconnectivity within this network has been linked to poorer goal-directed attention in MDD, and alpha (8–14 Hz) and fronto-central theta (4–7 Hz) oscillations support ignoring and top-down attention.
  • SSRIs generally do not improve attention despite mood improvement; vortioxetine is a notable exception, while catecholaminergic agents have stronger evidence for improving sustained, and possibly selective and divided, attention; brain stimulation and behavioral interventions show mixed or preliminary benefits.

Methods

  • Narrative review synthesizing cognitive neuroscience, RDoC, behavioral, neuroimaging, electrophysiological, and treatment literature on attention in MDD.
  • No primary dataset is reported; the paper reviews prior studies, including behavioral comparisons between MDD patients and healthy controls and treatment trials.
  • Main approach is qualitative synthesis across disciplines, with a stated focus on neutral-stimulus studies of top-down attention and exclusion of Stroop interference scores as measures of cognitive control.

Limitations

  • The paper states that MDD is highly heterogeneous, attention impairments may not be present in all depressed individuals, and group-level findings may obscure individual variability.
  • It notes that neural systems supporting attention sub-functions remain murky, treatment trials largely focus on clinical response rather than behavioral attention, and few report item-level data.
  • Evident from the text: this is a narrative review without a systematic search, meta-analysis, or formal effect-size synthesis, so conclusions depend on the selected literature.

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Registry

Crossref · 10.1038/s41398-019-0616-1

Cites

Statistics

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Claims the paper makes

0 of 140 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the authors' own data, there is no significant correlation between selective attention and worrying.

    “In our own data, we do not observe a significant correlation between selective attention and worrying20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Keller, A. S., Ball, T. M. & Williams, L. M. Deep phenotyping of attention impairments and the “Inattention Biotype” in major depressive disorder. Psychol. Med. 1–10 (2019). https://doi.org/10.1017/S0033291719002290. source

      Not checked in the free run.

  • Findingown data

    In the authors' own work, hypoconnectivity within the fronto-parietal attention network is directly linked to poorer goal-directed attention in major depressive disorder.

    “In our own work, we have directly linked hypoconnectivity within this fronto-parietal attention network to poorer goal-directed attention in MDD20.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Keller, A. S., Ball, T. M. & Williams, L. M. Deep phenotyping of attention impairments and the “Inattention Biotype” in major depressive disorder. Psychol. Med. 1–10 (2019). https://doi.org/10.1017/S0033291719002290. source

      Not checked in the free run.

  • Findingown data

    The authors' own data suggest that selective attention function does not correlate with insomnia or excessive worrying.

    “our own data suggest that selective attention function does not correlate with insomnia or excessive worrying20.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Keller, A. S., Ball, T. M. & Williams, L. M. Deep phenotyping of attention impairments and the “Inattention Biotype” in major depressive disorder. Psychol. Med. 1–10 (2019). https://doi.org/10.1017/S0033291719002290. source

      Not checked in the free run.

  • Premisecitation

    Unmedicated depressed individuals, including children, adolescents, and adults, perform worse than healthy controls on feature-based selective attention tasks requiring attention to a task-relevant feature while ignoring a distracting feature.

    “Many investigations of color-word reaction times have revealed that unmedicated depressed individuals (including children, adolescents, and adults) perform worse than healthy controls when required to attend to a task-relevant feature (e.g., color) while simultaneously ignoring a distracting feature (e.g., semantic meaning)16–19, including in an international sample of n = 1008 MDD participants”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [16] Kertzman, S. et al. Stroop performance in major depression: selective attention impairment or psychomotor slowness? J. Affect. Disord. 122, 167–173 (2010). source

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    • cites [17] Holmes, A. J. & Pizzagalli, D. A. Response conflict and frontocingulate dysfunction in unmedicated participants with major depression. Neuropsychologia 46, 2904–2913 (2008). source

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    • cites [18] Cataldo, M. G., Nobile, M., Lorusso, M. L., Battaglia, M. & Molteni, M. Impulsivity in depressed children and adolescents: a comparison between behavioral and neuropsychological data. Psychiatry Res. 136, 123–133 (2005). source

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    • cites [19] Degl’Innocenti, A., Ågren, H. & Bäckman, L. Executive deficits in major depression. Acta Psychiatr. Scand. 97, 182–188 (1998). source

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    • cites [20] Keller, A. S., Ball, T. M. & Williams, L. M. Deep phenotyping of attention impairments and the “Inattention Biotype” in major depressive disorder. Psychol. Med. 1–10 (2019). https://doi.org/10.1017/S0033291719002290. source

      Not checked in the free run.

  • Premisecitation

    Studies using the Flanker task do not observe a significant difference in spatial selective attention performance between unmedicated major depressive disorder patients and healthy controls.

    “More often than not, studies investigating spatial selective attention by using the Flanker task (identifying the direction of an arrow flanked by distracting arrows) do not observe a significant difference in performance between unmedicated MDD patients and healthy controls21,22.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [21] Ladouceur, C. D. et al. Altered error-relaed brain activity in youth with major depression. Developmental Cogn. Neurosci. 2, 351–362 (2012). source

      Not checked in the free run.

    • cites [22] Olvet, D. M., Klein, D. N. & Hajcak, G. Depression symptom severity and error-related brain activity. Psychiatry Res. 179, 30–37 (2010). source

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  • May combine two claims. 35
  • Classified as probably not a substantial claim. 14

  • May combine two claims.

    Interpretationreasoning

    Selective attention impairments in major depressive disorder may be specific to feature-based selective attention while spatial selective attention remains intact.

    “This might suggest that selective attention impairments in MDD are specific to feature-based selective attention while spatial selective attention remains intact”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The Flanker task used to assess spatial attention tends to be much less challenging than color- and word-naming tasks, with performance close to ceiling.

  • May combine two claims.

    Premisecitation

    Attention impairments in major depressive disorder negatively impact daily function and are associated with poorer clinical outcome.

    “Attention impairments in particular are known to negatively impact daily function3,4 and are associated with poorer clinical outcome5.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [3] Fehnel, S. E. et al. Patient-centered assessment of cognitive symptoms of depression. CNS Spectr. 21, 43–52 (2016). source

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    • cites [4] Cotrena, C., Branco, L. D., Shansis, F. M. & Fonseca, R. P. Executive function impairments in depression and bipolar disorder: association with functional impairment and quality of life. J. Affect. Disord. 190, 744–753 (2016). source

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    • cites [5] Majer, M. et al. Impaired divided attention predicts delayed response and risk to relapse in subjects with depressive disorders. Psychological Med. 34, 1453–1463 (2004). source

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Cognitive control most often requires attentional processes, and thus cognitive control tasks also test attention.

    “The RDoC working group states that “cognitive control most often requires attentional processes, and thus cognitive control tasks also test attention””
    • Also stated in: § Cognitive control · hedged
      “Chun et al.41 state that “To the extent that there are limitations in the number of alternatives that can be considered at any given time— and even broader set of responses and choices that can be made to these alternatives—cognitive control is intrinsically attentional.””
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [40] National Institute of Mental Health. Research Domain Criteria (RDoC): Cognitive Systems: Workshop Proceedings. [Internet]. Retrieved Aug 2019. Available from: https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/cognitive-systems-workshop-proceedings.shtml (2019).

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    • cites [41] Chun, M. M., Golomb, J. D. & Turk-Browne, N. B. A taxonomy of external and internal attention. Annu Rev. Psychol. 62, 73–101 (2011). source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Attention influences the choices we make as well as our learning of reward associations over time.

    “and that attention influences the choices we make as well as our learning of reward associations over time54.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Leong, Y.-C., Radulescu, A., Daniel, R., DeWoskin, V. & Niv, Y. Dynamic interaction between reinforcement learning and attention in multidimensional environments. Neuron 93, 451–463 (2017). source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Attention is a critical gating mechanism for sensory perception.

    “Once considered a bottleneck limiting sensory processing, attention is now appreciated as a critical gating mechanism for sensory perception, helping to form our fluid, organized, conscious experience from the abundant information bombarding our sensory systems.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Studies of unmedicated adults with major depressive disorder reveal impairments in performing two tasks simultaneously and in simultaneously attending auditory and visual stimuli to detect targets compared with healthy controls.

    “In the context of MDD, studies of unmedicated adults have revealed impairments in performing two tasks simultaneously34, and simultaneously attending both auditory and visual stimuli to detect targets35 compared with healthy controls.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [34] Lautenbacher, S., Spernal, J. & Krieg, J.-C. Divided and selective attention in panic disorder: a comparative study of patients with panic disorder, major depression and healthy controls. Eur. Arch. Psychiatry Clin. Neurosci. 252, 210–213 (2002). source

      Not checked in the free run.

    • cites [35] Thomas, P., Goudemand, M. & Rousseaux, M. Divided attention in major depression. Psychiatry Res. 81, 309–322 (1998). source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Gaze bias appears to both reflect and influence preferences.

    “Indeed, gaze bias appears to both reflect and influence preferences51”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] Shimojo, S., Simon, C., Shimojo, E. & Scheier, C. Gaze bias both reflects and influences preference. Nat. Neurosci. 6, 1317–1322 (2003). source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Attention plays a critical role in decision-making.

    “In addition to the profound influence of attention on perception, attention also appears to play a critical role in decision-making.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Reward-learning affects the allocation of attention with strong biases toward previously rewarded locations.

    “and reward-learning in turn affects the allocation of attention with strong biases toward previously rewarded locations52.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Chelazzi, L. et al. Altering spatial priority maps via reward-based learning. J. Neurosci. 34, 8594–8604 (2014). source

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    Premisecitation

    Selective attention is a requirement for effective multidimensional reinforcement learning.

    “Recent advances using computational modeling of behavior have shown that selective attention is a requirement for effective multidimensional reinforcement learning53”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Niv, Y. et al. Reinforcement learning in multidimensional environments relies on attention mechanisms. J. Neurosci. 35, 8145–8157 (2015). source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Cognitive control processes and top-down attention often share overlapping neural circuitry.

    “Moreover, cognitive control processes and top–down attention often share overlapping neural circuitry (see the section “Putative mechanisms of attention impairment”).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    Negative attentional biases in depression are exacerbated by general impairment of top-down attention allocation.

    “It is plausible that these negative attentional biases are exacerbated by general impairment of top–down attention allocation (and re-allocation toward goal-relevant information when something has inadvertently caught one’s attention).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Emotion and trait anxiety moderate the effect of attention on perceived contrast.

    “Barbot and Carrasco49 recently showed that emotion and trait anxiety moderate the effect of attention on perceived contrast, motivating future studies to provide more detailed characterizations of interactions between depressive symptoms and the effect of attention impairments on perception.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Barbot, A. & Carrasco, M. Emotion and anxiety potentiate the way attention alters visual appearance. Sci. Rep. 8, 5938 (2018). source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Low mood observed in depression may contribute to attentional impairments and attentional impairments may in turn perpetuate low mood.

    “thus low mood observed in depression may contribute to attentional impairments and attentional impairments may in turn perpetuate low mood.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Poorer divided attention is associated with delayed response and increased risk of relapse as well as higher suicidality.

    “while poorer divided attention is associated with delayed response and increased risk of relapse5 as well as higher suicidality37.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Majer, M. et al. Impaired divided attention predicts delayed response and risk to relapse in subjects with depressive disorders. Psychological Med. 34, 1453–1463 (2004). source

      Not checked in the free run.

    • cites [37] Kim, S. J. et al. The relationship between poor performance on attention tasks and increased suicidal ideation in adolescents. Eur. Child Adolesc. Psychiatry 24, 1361–1368 (2015). source

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    Premisecitation

    Regions with a large number of long distance connections tend to be optimal controllers.

    “(in line with the overarching finding that regions with a large number of long distance connections tend to be optimal controllers79.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [79] Gu, S. et al. Optimal trajectories of brain state transitions. NeuroImage 148, 305–317 (2017). source

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    Premisecitation

    The fronto-parietal attention network, including frontal eye fields, intra-parietal sulcus, medial prefrontal cortex, and superior parietal lobule, appears critical for the control of goal-directed attention with increasing involvement for more difficult tasks.

    “This network, which includes areas such as the frontal eye fields, intra-parietal sulcus, medial prefrontal cortex (mPFC), and superior parietal lobule, appears to be critical for the control of goal-directed attention75 with increasing involvement for more difficult tasks76.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [75] Corbetta, M. & Shulman, G. L. Control of goal-directed and stimulus-driven attention in the brain. Nat. Rev. Neurosci. 3, 201–215 (2002). source

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    • cites [76] Falkenberg, L. E., Specht, K. & Westerhausen, R. Attention and cognitive control networks assessed in a dichotic listening fmri study. Brain Cogn. 76, 276–285 (2011). source

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    Premisecitation

    Vortioxetine has demonstrated benefits for sustained and selective attention as well as depressive symptoms in adults with MDD.

    “Vortioxetine, a relatively newer serotonin reuptake inhibitor (SRI) with mixed agonist/antagonist/partial-agonist effects, is a notable exception that has demonstrated benefits for sustained and selective attention as well as depressive symptoms in adults with MDD103,104.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [103] Mahableshwarkar, A. R., Zajecka, J., Jacobson, W., Chen, Y. & Keefe, R. S. A randomized, placebo-controlled, active-reference, double-blind, flexible-dose study of the efficacy of vortioxetine on cognitive function in major depressive disorder. Neuropsychopharmacology 40, 2025–2037 (2015). source

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    • cites [104] McIntyre, R. S. et al. Efficacy of vortioxetine on cognitive functioning in working patients with major depressive disorder. J. Clin. psychiatry 78, 115–121 (2017). source

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    Premisecitation

    Distinctions between dorsal/ventral attention networks and central executive/cingulo-opercular networks remain unclear and inconsistent, with counter-evidence to distinct attention networks for bottom-up and top-down processing.

    “These distinctions, however, remain unclear and inconsistent, with more recent studies providing counter-evidence to this dogma of distinct attention networks for bottom-up and top–down processing85.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [85] Ahrens, M.-M., Veniero, D., Freund, I. M., Harvey, M. & Thut, G. Both dorsal and ventral attention network nodes are implicated in exogenously driven visuospatial anticipation. Cortex 117, 168–181 (2019). source

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    Premisecitation

    Modafinil can improve both sustained and selective attention in healthy subjects.

    “It can improve both sustained and selective attention in healthy subjects116,117”
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    • cites [116] Cope, Z. A. et al. Modafinil improves attentional performance in healthy, non-sleep deprived humans at doses not inducing hyperarousal across species. Neuropharmacology 125, 254–262 (2017). source

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    • cites [117] Ikeda, Y. et al. Modafinil enhances alerting-related brain activity in attention networks. Psychopharmacol. (Berl.) 234, 2077–2089 (2017). source

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    Premisecitation

    Psychostimulants remain the first-line treatment for ADHD and have been used as adjunctive therapy in MDD despite limited support from high-quality randomized controlled trials that examined mood-related symptom improvement alone.

    “Psychostimulants, which increase levels of both NE and DA in the striatum and cortex, remain the first-line treatment for ADHD and have also been used as an adjunctive therapy in MDD despite limited support from high quality, randomized, controlled trials that examined mood-related symptom improvement alone106.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [106] Corp, S. A., Gitlin, M. J. & Altshuler, L. L. A review of the use of stimulants and stimulant alternatives in treating bipolar depression and major depressive disorder. J. Clin. Psychiatry 75, 1010–1018 (2014). source

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    Premisecitation

    Some studies found improvements in selective attention with venlafaxine and with duloxetine, but the results have been mixed.

    “Some studies have found improvements in selective attention with venlafaxine122 and with duloxetine125, but the results have been mixed99,100.”
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    • cites [122] Tian, Y. et al. Venlafaxine treatment reduces the deficit of executive control of attention in patients with major depressive disorder. Sci. Rep. 6, 28028 (2016). source

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    • cites [125] Greer, T. L., Dunderajan, P., Grannemann, B. D., Kurian, B. T. & Trivedi, M. H. Does duloxetine improve cognitive function independently of its antidepressant effect in patients with major depressive disorder and subjective reports of cognitive dysfunction? Depress Res. Treat. 2014, 1–13 (2014). source

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    • cites [99] Shilyansky, C. et al. Effect of antidepressant treatment on cognitive impairments associated with depression: a randomised longitudinal study. Lancet Psychiatry 3, 425–435 (2016). source

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    Premisecitation

    Norepinephrine and dopamine are believed to modulate attention and other cognitive capabilities, generally with dose-response following classic inverted-U shaped curves.

    “Norepinephrine (NE) and dopamine (DA) are believed to modulate attention and other cognitive capabilities105, generally with dose–response following classic inverted-U shaped curves.”
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    • cites [105] Arnsten, A. F. Catecholamine influences on dorsolateral prefrontal cortical networks. Biol. Psychiatry 69, e89–e99 (2011). source

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    Premisecitation

    Modafinil increases feature-based selective attention and clinical symptoms in depressed patients.

    “and increase feature-based selective attention and clinical symptoms in depressed patients119.”
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    • cites [119] DeBattista, C., Lembke, A., Solvason, H. B., Ghebremichael, R. & Poirier, J. A prospective trial of modafinil as an adjunctive treatment of major depression. J. Clin. Psychopharmacol. 24, 87–90 (2004). source

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    Interpretationcitation

    There is strong evidence that dopaminergic agents can improve sustained attention, and possibly selective and divided attention.

    “There is strong evidence that dopaminergic agents can improve sustained attention, and possibly selective and divided attention.”
    Quote in the paperSubstantial claim

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    Premisecitation

    Methylphenidate and amphetamine have been demonstrated to improve selective attention.

    “Similarly, methylphenidate111,112 and amphetamine113 have been demonstrated to improve selective attention”
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    • cites [111] Paton, K. et al. Methylphenidate improves some but not all measures of attention, as measured by the TEA-Ch in medication-naive children with ADHD. Child Neuropsychol. 20, 303–318 (2014). source

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    • cites [112] ter Huurne, N. Methylphenidate alters selective attention by amplifying salience. Psychopharmacol. (Berl.) 232, 4317–4323 (2015). source

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    • cites [113] Servan-Schreiber, D., Carter, C. S., Bruno, R. M. & Cohen, J. D. Dopamine and the mechanisms of cognition: Part II. D-amphetamine effects in human subjects performing a selective attention task. Biol. Psychiatry 43, 723–729 (1998). source

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  • May combine two claims.

    Interpretationreasoning

    Together, alpha and theta oscillations appear to support normal attention function and may be a potential substrate of attention dysfunction in disorders such as depression.

    “Together, alpha and theta oscillations appear to support normal attention function and may be a potential substrate of attention dysfunction in disorders such as depression.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    An increasing body of data indicate that physical exercise has preventative and therapeutic effects for mood-related symptoms of depression.

    “An increasing body of data indicate that physical exercise has preventative and therapeutic effects for mood-related symptoms of depression139.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [139] Deslandes, A. C. et al. Effect of aerobic training on EEG alpha asymmetry and depressive symptoms in the elderly: a 1-year follow-up study. Braz. J. Med. Biol. Res. 43, 585–592 (2010). source

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    Premisecitation

    The fronto-parietal attention network synchronizes in the theta band and includes areas of the mPFC.

    “Moreover, the fronto-parietal attention network (which also synchronizes in the theta band98); includes areas of the mPFC.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [98] Fellrath, J., Mottaz, A., Schnider, A., Guggisberg, A. G. & Ptak, R. Theta-band functional connectivity in the dorsal fronto-parietal network predicts goal-directed attention. Neuropsychologia 92, 20–30 (2016). source

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    Premisecitation

    More recent studies using neurofeedback-assisted technology-supported mindfulness training have revealed selective attention improvement and enhancement in well-being in healthy individuals.

    “More recent studies using neurofeedback-assisted technology-supported mindfulness training (N-tsMT) have revealed selective attention improvement and enhancement in well-being in healthy individuals150.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [150] Bhayee, S. et al. Attentional and affective consequences of technology supported mindfulness training: a randomised, active control, efficacy trial. BMC Psychol. 4, 60 (2016). source

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    Premisecitation

    Prior systematic reviews of DLPFC stimulation effects on cognition across psychiatric disorders found no improvement in attention domains and only found significant improvements in working memory and verbal memory.

    “This finding is in accordance with prior systematic reviews of DLPFC stimulation effects on cognition across psychiatric disorders which found no improvement in attention domains (including selective, sustained, and divided) and only found significant improvements in working memory137 and verbal memory138.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [137] Martin, D. M., McClintock, S. M., Forster, J. & Loo, C. K. Does therapeutic repetitive transcranial magnetic stimulation cause cognitive enhancing effects in patients with neuropsychiatric conditions? A systematic review and meta-analysis of randomized controlled trials. Neuropsychol. Rev. 26, 295–309 (2016). source

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    • cites [138] Demirtas-Tatlidede, A., Vhabzadeh-Hagh, A. M. & Pascual-Leone, A. Can non-invasive brain stimulation enhance cognition in neuropsychiatric disorders? Neuropharmacology 64, 566–578 (2012). source

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    Premisecitation

    A meta-analysis found that computerized training improved mood symptoms and attention.

    “and a meta-analysis found that computerized training improved mood symptoms and attention153.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [153] Motter, J. N. et al. Computerized cognitive training and functional recovery in major depressive disorder: a meta-analysis. J. Affect. Disord. 189, 184–191 (2016). source

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    Premisecitation

    The canonical stress pathway, involving the hypothalamus-pituitary-adrenal axis, exhibits dysregulation in depression associated with increased cortisol and subsequent neuronal atrophy in the hippocampus and mPFC.

    “The canonical stress pathway, involving the hypothalamus–pituitary–adrenal axis, exhibits dysregulation in depression (for review ref. 155) associated with increased cortisol156 and subsequent neuronal atrophy in the hippocampus157 and mPFC158.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [155] Iwata, M., Ota, K. T. & Duman, R. S. The inflammasome: pathways linking psychological stress, depression, and systemic illnesses. Brain, Behav., Immun. 31, 105–114 (2013). source

      Not checked in the free run.

    • cites [156] Burke, H. M., Davis, M. C., Otte, C. & Mohr, D. C. Depression and cortisol responses to psychological stress: a meta-analysis. Psychoneuroendocrinology 30, 846–856 (2005). source

      Not checked in the free run.

    • cites [157] Sapolsky, R. M. Glucocorticoids and hippocampal atrophy in neuropsychiatric disorders. Arch. Gen. Psychiatry 57, 925–935 (2000). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Computerized cognitive training apps have not always outperformed control interventions and tend to have high drop-out rates that are worse with more severe depression.

    “Furthermore, these apps have not always outperformed control interventions and tend to have high drop-out rates that are worse with more severe depression154.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [154] Arean, P. A. et al. The use and effectiveness of mobile apps for depression: results from a fully remote clinical trial. J. Med. Internet Res. 18, e330 (2016). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    TMS and tDCS have been evidenced to improve both selective attention via targeting the DLPFC in healthy controls and sustained attention in depressed adults.

    “TMS and tDCS have been evidenced to improve both selective attention via targeting the DLPFC in healthy controls131 and sustained attention in depressed adults132.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [131] Hwang, J. H., Kim, S. H., Park, C. S., Bang, S. A. & Kim, S. E. Acute high-frequency rTMS of the left dorsolateral prefrontal cortex and attentional control in healthy young men. Brain Res. 1329, 152–158 (2010). source

      Not checked in the free run.

    • cites [132] Levkovitz, Y. Deep transcranial magnetic stimulation over the prefrontal cortex: evaluation of antidepressant and cognitive effects in depressive patients. Brain Stimul. 2, 188–200 (2009). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Childhood stress predicted both higher depressive symptoms and worse attention.

    “and childhood stress predicted both higher depressive symptoms and worse attention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [163] Mac Giollabhui, N., Olino, T. M., Nielsen, J., Abramson, L. Y. & Alloy, L. B. Is worse attention a risk factor for or a consequence of depression, or are worse attention and depression better accounted for by stress? A prospective test of three hypotheses. Clin. Psychological Sci. 7, 93–109 (2019). source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Benefits of computerized cognitive training may generalize beyond the specific cognitive tasks practiced, such as improving untrained measures of attention, reducing negativity bias, and enhancing daily functioning, suggesting far transfer effects.

    “Notably, the benefits of computerized cognitive training may generalize beyond the specific cognitive tasks practiced, such as improving untrained measures of attention, reducing negativity bias, and enhancing daily functioning, suggesting far transfer effects152,153.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [152] Anguera, J. A., Gunning, F. M. & Areán, P. A. Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof‐of‐concept randomized trial. Depression Anxiety 34, 508–517 (2017). source

      Not checked in the free run.

    • cites [153] Motter, J. N. et al. Computerized cognitive training and functional recovery in major depressive disorder: a meta-analysis. J. Affect. Disord. 189, 184–191 (2016). source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Giollabhui et al. used a longitudinal sample to investigate selective, sustained, and divided attention, and showed that the interactions among these pathways may be complex.

    “Giollabhui et al.163 used a longitudinal sample to investigate selective, sustained, and divided attention, and showed that the interactions among these pathways may be complex.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [163] Mac Giollabhui, N., Olino, T. M., Nielsen, J., Abramson, L. Y. & Alloy, L. B. Is worse attention a risk factor for or a consequence of depression, or are worse attention and depression better accounted for by stress? A prospective test of three hypotheses. Clin. Psychological Sci. 7, 93–109 (2019). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent systematic review found it difficult to draw firm conclusions regarding effects of brain stimulation on attention in depression, with several studies not finding effects on Stroop tasks or sustained attention.

    “However, a recent systematic review found it difficult to draw firm conclusions regarding effects of brain stimulation on attention in depression with several studies not finding effects on Stroop tasks or sustained attention136.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [136] Iimori, T. et al. Effectiveness of the prefrontal repetitive transcranial magnetic stimulation on cognitive profiles in depression, schizophrenia, and Alzheimer’s disease: a systematic review. Prog. Neuropsychopharmacol. Biol. Psychiatry 88, 31–40 (2019). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physical exercise has been demonstrated to improve selective attention behaviorally in healthy controls as well as young adult and older adult MDD patients, though these effects appeared short-lived and recent reviews find mixed results.

    “Physical exercise has also been demonstrated to improve selective attention behaviorally in both healthy controls140 as well as young adult141 and older adult MDD patients142, though these effects appeared to be short-lived and recent reviews find mixed results143,144.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [140] Smith, P. J. et al. Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosom. Med. 72, 239–252 (2010). source

      Not checked in the free run.

    • cites [141] Kubesch, S. et al. Aerobic endurance exercise improves executive functions in depressed patients. J. Clin. Psychiatry 64, 1005–1012 (2003). source

      Not checked in the free run.

    • cites [142] Vasques, P. E., Moraes, H., Silveira, H., Deslandes, A. C. & Laks, J. Acute exercise improves cognition in the depressed elderly: the effect of dual-tasks. Clinics 66, 1553–1557 (2011). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The most common target in MDD has been left dorsolateral prefrontal cortex, generally considered a node in the cognitive control network, albeit one that interfaces with the fronto-parietal attention network.

    “The most common target in MDD has been left dorsolateral prefrontal cortex (DLPFC), which is generally considered to be a node in the cognitive control network, albeit one that interfaces with the fronto-parietal attention network130.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [130] Marek, S. & Dosenbach, N. U. F. The frontoparietal network: function, electrophysiology, and importance of individual precision mapping. Dialogues Clin. Neurosci. 20, 133–140 (2018). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Noradrenaline is a major component of the inverted-U shaped physiologic response to stress, and alpha2a adrenergic receptors in the prefrontal cortex mediate many aspects of cognitive control.

    “Noradrenaline is a major component of the inverted-U shaped physiologic response to stress, and alpha2a adrenergic receptors in the prefrontal cortex127 mediate many aspects of cognitive control128.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [127] Arnsten, A. F. Stress weakens prefrontal networks: molecular insults to higher cognition. Nat. Neurosci. 18, 1376–1385 (2015). source

      Not checked in the free run.

    • cites [128] Berridge, C. W. & Arnsten, A. F. Psychostimulants and motivated behavior: arousal and cognition. Neurosci. Biobehav Rev. 37(9 Pt A), 1976–1984 (2013). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mindfulness meditation has been shown to improve selective attention measured independently in addition to improving mood-related symptoms of MDD and increasing alpha oscillations.

    “Mindfulness meditation (MM) involves rehearsing the skill of selectively attending to one sensation (e.g., breath) while ignoring distracting thoughts145, and has been shown to improve selective attention measured independently146 in addition to improving mood-related symptoms of MDD147,148 and increasing alpha oscillations149.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [146] Chiesa, A., Calati, R. & Serretti, A. Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. Clin. Psychol. Rev. 31, 449–464 (2011). source

      Not checked in the free run.

    • cites [147] Wielgosz, J., Goldberg, S. B., Kral, T. R. A., Dunne, J. D. & Davidson, R. J. Mindfulness meditation and psychopathology. Annu Rev. Clin. Psychol. 15, 285–316 (2019). source

      Not checked in the free run.

    • cites [148] Goldberg, S. B. et al. Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: a meta-analysis. Cogn. Behav. Ther. 8, 1–18 (2019).

      Not checked in the free run.

43 of 43

  • The paper relies on this without support.

    Attention problems in major depressive disorder are not alleviated by current first-line treatments.

    “these attention problems are not alleviated by current first-line treatments”
    “we discuss the failure of current first-line treatments to alleviate attention impairments in MDD”

  • The paper relies on this without support.

    Not all depressed individuals endorse attention problems as a core symptom.

    “supported by the observation that not all depressed individuals endorse attention problems as a core symptom”

  • The paper relies on this without support.

    The Flanker task used to assess spatial attention tends to be much less challenging than color- and word-naming tasks, with performance close to ceiling.

    “However, it is important to note that the Flanker task used to assess spatial attention tends to be much less challenging than color- and word-naming tasks, with performance close to ceiling.”

  • The paper relies on this without support.

    Cognitive dysfunction is a hallmark of major depressive disorder contributing to disability.

    “Although cognitive dysfunction is a hallmark of MDD contributing to disability, it is not well understood, especially in comparison with the mood features of MDD.”

  • The paper relies on this without support.

    Treatment trials in depression have largely focused on clinical measures of response rather than on behavioral measures of attention, and very few report item-level data, making it challenging to parse out specific changes in attention.

    “Treatment trials in depression have largely focused on clinical measures of response rather than on behavioral measures of attention and very few report item-level data, making it challenging to parse out specific changes in attention.”

  • The paper relies on this without support.

    Attention impairments are a debilitating symptom for many depressed individuals.

    “Given that attention impairments are a debilitating symptom for many depressed individuals and are not alleviated by current first-line antidepressant treatments”
6 of 6

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?

  • Selective attention, interference processing, and working memory are cognitive domains all impacted in depression.

    “cognitive domains that are all impacted in depression [93–96]”

    From Personalized machine learning guided intervention for optimizing lifestyle behaviors in depression: a pilot study (2026) · cites this paper as [93]

    The ‘Selective attention impairment’ section reports poorer performance by depressed participants on feature-based selective-attention tasks. The paper mentions memory impairments generally, but does not establish a working-memory impairment; its ‘Cognitive control’ section explicitly excludes interference scores from the studies reviewed, so it does not establish impaired interference processing either. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Several mental health conditions, including depression and anxiety, are notable for impairments in cognitive flexibility and attentional control.

    “Several mental health conditions, including depression and anxiety, are notable for impairments in cognitive flexibility and attentional control.”

    From The Role of Exercise in Management of Mental Health Disorders: An Integrative Review (2021) · cites this paper as [88]

  • In several mental health conditions, difficulties include poor set-shifting abilities, selective attention, and distractibility.

    “Difficulties include poor set-shifting abilities (i.e., difficulty switching between tasks or altering behavior in response to feedback) (88), selective attention, and distractibility.”

    From The Role of Exercise in Management of Mental Health Disorders: An Integrative Review (2021) · cites this paper as [88]

The citation lists haven’t been fetched yet

References 168 · Cited by 329

Research works printed but not linked: 2

  1. National Institute of Mental Health. Research Domain Criteria (RDoC): Cognitive Systems: Workshop Proceedings. [Internet]. Retrieved Aug 2019. Available from: https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/cognitive-systems-workshop-proceedings.shtml (2019).
  2. Loftus, E. Eyewitness Testimony (Harvard University Press, London, UK, 1979).

Authors
Keller, A. S., Leikauf, J. E., Holt-Gosselin, B., Staveland, B. R., & Williams, L. M.
Affiliations
Stanford Medicine (US)
Corresponding author
Williams, Leanne M.
ORCID
Venue
Translational Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2019-11-07
Volume
9
Issue
1
Pages
279-279
ISSN
2158-3188 (ISSN-L)
DOI
10.1038/s41398-019-0616-1
PMC
PMC6838308
OpenAlex
W2982733939
Cited by
329
References
168
Citations by year
2026: 47 · 2025: 65 · 2024: 65 · 2023: 67 · 2022: 41 · 2021: 33 · 2020: 9 · 2019: 1 · 2017: 1
FWCI
2.66
Type
journal article
Language
en
Update notices
correction (2020-02-12)
Open access
Licence
Locations
  • Translational Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
U.S. Department of Health & Human Services | National Institutes of Health (R01 MH101496, U01 MH109985, T32 MH020016)
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, attention deficits, top-down attention, selective attention, sustained attention, divided attention, cognitive control, negative bias, large-scale neural networks, brain stimulation, pharmacological interventions, behavioral interventions, concentration difficulties
MeSH terms
Attentional Bias, Brain, Major Depressive Disorder, Emotions, Humans, Neuropsychological Tests, Selective Serotonin Reuptake Inhibitors, Precision Medicine

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