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Hot and cold cognition in depression

Published online by Cambridge University Press:  12 March 2013

Jonathan P. Roiser*
UCL Institute of Cognitive Neuroscience, London, UK
Barbara J. Sahakian
University of Cambridge Department of Psychiatry and MRC/Wellcome Trust Behavioural and Clinical Neuroscience Institute, Addenbrooke's Hospital, Cambridge, UK
Address for correspondence: Jonathan Roiser, UCL Institute of Cognitive Neuroscience, 17 Queen Square, London WC1N 3AR, UK. Email


We discuss the importance of cognitive abnormalities in unipolar depression, drawing the distinction between “hot” (emotion-laden) and “cold” (emotion-independent) cognition. “Cold” cognitive impairments are present reliably in unipolar depression, underscored by their presence in the diagnostic criteria for major depressive episodes. There is good evidence that some “cold” cognitive abnormalities do not disappear completely upon remission, and that they predict poor response to antidepressant drug treatment. However, in many studies the degree of impairment is moderately related to symptoms. We suggest that “cold” cognitive deficits in unipolar depression may in part be explicable in terms of alterations in “hot” processing, particularly on tasks that utilize feedback, on which depressed patients have been reported to exhibit a “catastrophic response to perceived failure.” Other abnormalities in “hot” cognition are commonly observed on tasks utilizing emotionally valenced stimuli, with numerous studies reporting mood-congruent processing biases in depression across a range of cognitive domains. Additionally, an emerging literature indicates reliable reward and punishment processing abnormalities in depression, which are especially relevant for hard-to-treat symptoms such as anhedonia. Both emotional and reward biases are strongly influenced by manipulations of the neurochemical systems targeted by antidepressant drugs. Such a pattern of “hot” and “cold” cognitive abnormalities is consistent with our cognitive neuropsychological model of depression, which proposes central roles for cognitive abnormalities in the generation, maintenance, and treatment of depressive symptoms. Future work should examine in greater detail the role that “hot” and “cold” cognitive processes play in mediating symptomatic improvement following pharmacological, psychological, and novel brain circuit-level interventions.

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1.World Health Organisation. The global burden of disease: 2004 update. Geneva: World Health Organisation; 2008.Google Scholar
2.McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S. Paying the price: the cost of mental health care in England to 2026. London: The Kings Fund; 2008.Google Scholar
3.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). Arlington, VA: American Psychiatric Press; 2002.Google Scholar
4.Potter, GG, Kittinger, JD, Wagner, HR, Steffens, DC, Krishnan, KR. Prefrontal neuropsychological predictors of treatment remission in late-life depression. Neuropsychopharmacology. 2004; 29(12): 22662271.CrossRefGoogle ScholarPubMed
5.Hasler, G, Drevets, WC, Manji, HK, Charney, DS. Discovering endophenotypes for major depression. Neuropsychopharmacology. 2004; 29(10): 17651781.CrossRefGoogle ScholarPubMed
6.Cavenar, JO, Maltbie, AA, Austin, L. Depression simulating organic brain disease. Am J Psychiatry. 1979; 136(4B): 521523.Google ScholarPubMed
7.Burt, DB, Zembar, MJ, Niederehe, G. Depression and memory impairment: a meta-analysis of the association, its pattern, and specificity. Psychol Bull. 1995; 117(2): 285305.CrossRefGoogle ScholarPubMed
8.Veiel, HO. A preliminary profile of neuropsychological deficits associated with major depression. J Clin Exp Neuropsychol. 1997; 19(4): 587603.CrossRefGoogle ScholarPubMed
9.Porter, RJ, Gallagher, P, Thompson, JM, Young, AH. Neurocognitive impairment in drug-free patients with major depressive disorder. Br J Psychiatry. 2003; 182: 214220.CrossRefGoogle ScholarPubMed
10.Elliott, R, Sahakian, BJ, McKay, AP, etal. Neuropsychological impairments in unipolar depression: the influence of perceived failure on subsequent performance. Psychol Med. 1996; 26(5): 975989.CrossRefGoogle ScholarPubMed
11.Swainson, R, Hodges, JR, Galton, CJ, etal. Early detection and differential diagnosis of Alzheimer's disease and depression with neuropsychological tasks. Dement Geriatr Cogn Disord. 2001; 12(4): 265280.CrossRefGoogle ScholarPubMed
12.Snyder, HR. Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: a meta-analysis and review. Psychol Bull. 2013; 139(1): 81132.CrossRefGoogle ScholarPubMed
13.Beats, BC, Sahakian, BJ, Levy, R. Cognitive performance in tests sensitive to frontal lobe dysfunction in the elderly depressed. Psychol Med. 1996; 26(3): 591603.CrossRefGoogle ScholarPubMed
14.McDermott, LM, Ebmeier, KP. A meta-analysis of depression severity and cognitive function. J Affect Disord. 2009; 119(1–3): 18.CrossRefGoogle ScholarPubMed
15.Pimontel, MA, Culang-Reinlieb, ME, Morimoto, SS, Sneed, JR. Executive dysfunction and treatment response in late-life depression. Int J Geriatr Psychiatry. 2012; 27(9): 893899.CrossRefGoogle ScholarPubMed
16.Story, TJ, Potter, GG, Attix, DK, Welsh-Bohmer, KA, Steffens, DC. Neurocognitive correlates of response to treatment in late-life depression. Am J Geriatr Psychiatry. 2008; 16(9): 752759.CrossRefGoogle ScholarPubMed
17.McLennan, SN, Mathias, JL. The depression-executive dysfunction (DED) syndrome and response to antidepressants: a meta-analytic review. Int J Geriatr Psychiatry. 2010; 25(10): 933944.CrossRefGoogle ScholarPubMed
18.Arean, PA, Raue, P, Mackin, RS, etal. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. Am J Psychiatry. 2010; 167(11): 13911398.CrossRefGoogle ScholarPubMed
19.Abolfazli, R, Hosseini, M, Ghanizadeh, A, etal. Double-blind randomized parallel-group clinical trial of efficacy of the combination fluoxetine plus modafinil versus fluoxetine plus placebo in the treatment of major depression. Depress Anxiety. 2011; 28(4): 297302.CrossRefGoogle ScholarPubMed
20.Glahn, DC, Curran, JE, Winkler, AM, etal. High dimensional endophenotype ranking in the search for major depression risk genes. Biol Psychiatry. 2012; 71(1): 614.CrossRefGoogle ScholarPubMed
21.Elliott, R, Sahakian, BJ, Herrod, JJ, Robbins, TW, Paykel, ES. Abnormal response to negative feedback in unipolar depression: evidence for a diagnosis specific impairment. J Neurol Neurosurg Psychiatry. 1997; 63(1): 7482.CrossRefGoogle ScholarPubMed
22.Murphy, FC, Michael, A, Robbins, TW, Sahakian, BJ. Neuropsychological impairment in patients with major depressive disorder: the effects of feedback on task performance. Psychol Med. 2003; 33(3): 455467.CrossRefGoogle ScholarPubMed
23.Roiser, JP, Elliott, R, Sahakian, BJ. Cognitive mechanisms of treatment in depression. Neuropsychopharmacology. 2012; 37(1): 117136.CrossRefGoogle ScholarPubMed
24.Joormann, J, Gotlib, IH. Is this happiness I see? Biases in the identification of emotional facial expressions in depression and social phobia. J Abnorm Psychol. 2006; 115(4): 705714.CrossRefGoogle ScholarPubMed
25.Matt, GE, Vazquez, C, Campbell, WK. Mood-congruent recall of affectively toned stimuli—a meta-analytic review. Clin Psychol Rev. 1992; 12(2): 227255.CrossRefGoogle Scholar
26.Gotlib, IH, Joormann, J. Cognition and depression: current status and future directions. Annu Rev Clin Psychol. 2010; 6: 285312.CrossRefGoogle ScholarPubMed
27.Joormann, J, Gotlib, IH. Updating the contents of working memory in depression: interference from irrelevant negative material. J Abnorm Psychol. 2008; 117(1): 182192.CrossRefGoogle ScholarPubMed
28.Murphy, FC, Sahakian, BJ, Rubinsztein, JS, etal. Emotional bias and inhibitory control processes in mania and depression. Psychol Med. 1999; 29(6): 13071321.CrossRefGoogle ScholarPubMed
29.Erickson, K, Drevets, WC, Clark, L, etal. Mood-congruent bias in affective go/no-go performance of unmedicated patients with major depressive disorder. Am J Psychiatry. 2005; 162(11): 21712173.CrossRefGoogle ScholarPubMed
30.Eshel, N, Roiser, JP. Reward and punishment processing in depression. Biol Psychiatry. 2010; 68(2): 118124.CrossRefGoogle ScholarPubMed
31.Berton, O, Hahn, CG, Thase, ME. Are we getting closer to valid translational models for major depression? Science. 2012; 338(6103): 7579.CrossRefGoogle ScholarPubMed
32.Taylor Tavares, JV, Clark, L, Furey, ML, etal. Neural basis of abnormal response to negative feedback in unmedicated mood disorders. Neuroimage. 2008; 42(3): 11181126.CrossRefGoogle ScholarPubMed
33.Henriques, JB, Davidson, RJ. Decreased responsiveness to reward in depression. Cognition and Emotion. 2000; 14: 711724.CrossRefGoogle Scholar
34.Robinson, OJ, Cools, R, Carlisi, CO, Sahakian, BJ, Drevets, WC. Ventral striatum response during reward and punishment reversal learning in unmedicated major depressive disorder. Am J Psychiatry. 2012; 169(2): 152159.CrossRefGoogle ScholarPubMed
35.Rogers, RD, Everitt, BJ, Baldacchino, A, etal. Dissociable deficits in the decision-making cognition of chronic amphetamine abusers, opiate abusers, patients with focal damage to prefrontal cortex, and tryptophan-depleted normal volunteers: evidence for monoaminergic mechanisms. Neuropsychopharmacology. 1999; 20(4): 322339.CrossRefGoogle ScholarPubMed
36.Murphy, FC, Rubinsztein, JS, Michael, A, etal. Decision-making cognition in mania and depression. Psychol Med. 2001; 31(4): 679693.CrossRefGoogle ScholarPubMed
37.Rawal, A, Collishaw, S, Thapar, A, Rice, F. “The risks of playing it safe”: a prospective longitudinal study of response to reward in the adolescent offspring of depressed parents. Psychol Med. 2013; 43(1): 2738.CrossRefGoogle ScholarPubMed
38.Treadway, MT, Bossaller, NA, Shelton, RC, Zald, DH. Effort-based decision-making in major depressive disorder: a translational model of motivational anhedonia. J Abnorm Psychol. 2012; 121(3): 553558.CrossRefGoogle ScholarPubMed
39.Roiser, JP, Stephan, KE, den Ouden, HE, etal. Do patients with schizophrenia exhibit aberrant salience? Psychol Med. 2009; 39(2): 199209.CrossRefGoogle ScholarPubMed
40.Murray, GK, Clark, L, Corlett, PR, etal. Incentive motivation in first-episode psychosis: a behavioural study. BMC Psychiatry. 2008; 8: 34.CrossRefGoogle ScholarPubMed
41.Montague, PR, Dolan, RJ, Friston, KJ, Dayan, P. Computational psychiatry. Trends Cogn Sci. 2012; 16(1): 7280.CrossRefGoogle ScholarPubMed
42.Chase, HW, Frank, MJ, Michael, A, etal. Approach and avoidance learning in patients with major depression and healthy controls: relation to anhedonia. Psychol Med. 2010; 40(3): 433440.CrossRefGoogle ScholarPubMed
43.Kunisato, Y, Okamoto, Y, Ueda, K, etal. Effects of depression on reward-based decision making and variability of action in probabilistic learning. J Behav Ther Exp Psychiatry. 2012; 43(4): 10881094.CrossRefGoogle ScholarPubMed
44.Beck, AT. Cognitive Therapy and Emotional Disorders. New York: International University Press; 1976.Google Scholar
45.Harmer, CJ, O'Sullivan, U, Favaron, E, etal. Effect of acute antidepressant administration on negative affective bias in depressed patients. Am J Psychiatry. 2009; 166(10): 11781184.CrossRefGoogle ScholarPubMed
46.Roiser, JP, McLean, A, Ogilvie, AD, etal. The subjective and cognitive effects of acute phenylalanine and tyrosine depletion in patients recovered from depression. Neuropsychopharmacology. 2005; 30(4): 775785.CrossRefGoogle ScholarPubMed
47.Roiser, JP, Levy, J, Fromm, SJ, etal. The effect of acute tryptophan depletion on the neural correlates of emotional processing in healthy volunteers. Neuropsychopharmacology. 2008; 33(8): 19922006.CrossRefGoogle ScholarPubMed
48.Harmer, CJ, Goodwin, GM, Cowen, PJ. Why do antidepressants take so long to work? A cognitive neuropsychological model of antidepressant drug action. Br J Psychiatry. 2009; 195(2): 102108.CrossRefGoogle Scholar
49.George, MS, Taylor, JJ, Short, EB. The expanding evidence base for rTMS treatment of depression. Curr Opin Psychiatry. 2013; 26(1): 1318.CrossRefGoogle ScholarPubMed
50.George, MS. Transcranial magnetic stimulation for the treatment of depression. Expert Rev Neurother. 2010; 10(11): 17611772.CrossRefGoogle ScholarPubMed
51.O'Reardon, JP, Solvason, HB, Janicak, PG, etal. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007; 62(11): 12081216.CrossRefGoogle ScholarPubMed
52.Walsh, ND, Williams, SC, Brammer, MJ, etal. A longitudinal functional magnetic resonance imaging study of verbal working memory in depression after antidepressant therapy. Biol Psychiatry. 2007; 62(11): 12361243.CrossRefGoogle ScholarPubMed
53.Martis, B, Alam, D, Dowd, SM, etal. Neurocognitive effects of repetitive transcranial magnetic stimulation in severe major depression. Clin Neurophysiol. 2003; 114(6): 11251132.CrossRefGoogle ScholarPubMed
54.Leyman, L, De Raedt, R, Vanderhasselt, MA, Baeken, C. Influence of high-frequency repetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex on the inhibition of emotional information in healthy volunteers. Psychol Med. 2009; 39(6): 10191028.CrossRefGoogle ScholarPubMed
55.Vanderhasselt, MA, De Raedt, R, Leyman, L, Baeken, C. Acute effects of repetitive transcranial magnetic stimulation on attentional control are related to antidepressant outcomes. J Psychiatry Neurosci. 2009; 34(2): 119126.Google ScholarPubMed
56.Leyman, L, De Raedt, R, Vanderhasselt, MA, Baeken, C. Effects of repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex on the attentional processing of emotional information in major depression: a pilot study. Psychiatry Res. 2011; 185(1–2): 102107.CrossRefGoogle ScholarPubMed
57.Mayberg, HS, Lozano, AM, Voon, V, etal. Deep brain stimulation for treatment-resistant depression. Neuron. 2005; 45(5): 651660.CrossRefGoogle ScholarPubMed
58.Drevets, WC. Neuroimaging and neuropathological studies of depression: implications for the cognitive-emotional features of mood disorders. Curr Opin Neurobiol. 2001; 11(2): 240249.CrossRefGoogle ScholarPubMed
59.Mayberg, HS, Liotti, M, Brannan, SK, etal. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry. 1999; 156(5): 675682.Google ScholarPubMed
60.Vidal-Gonzalez, I, Vidal-Gonzalez, B, Rauch, SL, Quirk, GJ. Microstimulation reveals opposing influences of prelimbic and infralimbic cortex on the expression of conditioned fear. Learn Mem. 2006; 13(6): 728733.CrossRefGoogle ScholarPubMed
61.Victor, TA, Furey, ML, Fromm, SJ, Ohman, A, Drevets, WC. Relationship between amygdala responses to masked faces and mood state and treatment in major depressive disorder. Arch Gen Psychiatry. 2010; 67(11): 11281138.CrossRefGoogle ScholarPubMed
62.Grimm, S, Boesiger, P, Beck, J, etal. Altered negative BOLD responses in the default-mode network during emotion processing in depressed subjects. Neuropsychopharmacology. 2009; 34(4): 932943.CrossRefGoogle ScholarPubMed
63.O'Nions, EJ, Dolan, RJ, Roiser, JP. Serotonin transporter genotype modulates subgenual response to fearful faces using an incidental task. J Cogn Neurosci. 2011; 23(11): 36813693.CrossRefGoogle ScholarPubMed
64.Hollon, SD, Jarrett, RB, Nierenberg, AA, etal. Psychotherapy and medication in the treatment of adult and geriatric depression: which monotherapy or combined treatment? J Clin Psychiatry. 2005; 66(4): 455468.CrossRefGoogle ScholarPubMed
65.Owens, M, Goodyer, IM, Wilkinson, P, etal. 5-HTTLPR and early childhood adversities moderate cognitive and emotional processing in adolescence. PLoS ONE. 2012; 7(11): e48482.CrossRefGoogle ScholarPubMed
66.Kessler, RC, Berglund, P, Demler, O, etal. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6): 593602.CrossRefGoogle ScholarPubMed
67.Beddington, J, Cooper, CL, Field, J, etal. The mental wealth of nations. Nature. 2008; 455(7216): 10571060.CrossRefGoogle ScholarPubMed
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