Ideally, treatments for depression would reflect underlying neurobiology, yet neurobiological and clinical models are rarely brought together. Cognitive dysfunction related to the processing of emotionally salient cues could be a helpful example of a neurobiologically informed treatment target.
Cognitive impairments are seen in both acute and remitted depression, suggesting that they may be a trait as well as a state marker of mood disorder. Recent genome-wide association studies have identified cognitive dysfunction as a symptom dimension rooted in neurobiology.
Cognitive function and emotional processing are closely related through social cognition. The ability to perceive and interpret socially relevant information, including the mental states of others, is required for successful interpersonal relationships. Examples include the recognition of cues contained in facial expression and prosody.
Depression is characterised by a bias towards perception of negative emotions but this ought to be capable of correction through specific training, Bernhard Baune argues in a recent issue of the Australian & New Zealand Journal of Psychiatry.1
His commentary follows the proposal – by Richard Porter and colleagues (from the University of Otago, Christchurch, New Zealand) – of an approach to treatment that they term “cognitive and affective remediation training”.2
This is based on the idea (derived, in part, from the treatment of people with schizophrenia) that improved psychosocial functioning requires the targeting of interlinked cognitive and affective domains.
It also relates to evidence that depression is associated with decreased recruitment of executive control networks in regions such as the dorsolateral prefrontal cortex (DLPFC), and early suggestions that tasks which increase recruitment of this area improve depressive symptoms.
It has been difficult to relate specific aspects of cognitive function to specific neural networks but there is interest in findings suggesting DLPFC involvement, Professor Baune says. We await further evidence but an approach that addresses both the cognitive and affective aspects of depression should be encouraged, he concludes.
