Up and Down: Neurocognitive Vulnerability to Recurrent Depression

Major Depressive Disorder (MDD) is a prevalent psychiatric disorder with a highly recurrent nature. Relapse rates are even rising with subsequent episodes. More insight into neurocognitive processes in relation to (1) the remitted state, (2) previous disease burden, (3) future relapse risk and (4) preventive treatment effects would benefit identification of patients at risk and improvement of preventive interventions.

Here we found that remitted MDD patients show abnormal brain activation when dealing with emotional images uninstructed, possibly underlying less functional automatic selection of regulation strategies. Also in daily life they tend to use dysfunctional strategies, such as rumination. Additionally, they show abnormal (neural and behavioural) dampening of positive emotions. Brain functioning related to regulation of negative emotions is affected by previous disease burden, and possibly underlies the accumulating vulnerability to recurrence with subsequent episodes. Furthermore, a network of brain areas that is related to internal mental processes is predictive of future relapse, together with a self-reported lack of control over negative self-related thinking. Finally, preventive cognitive therapy leads to improved neural regulation capacity and behavioural regulation outcomes, and to stabilisation of affect and symptoms.

These findings lead to several recommendations that might improve preventive interventions: a shift of focus towards savouring positive emotions, selecting functional regulation strategies in daily life, and gaining control over negative self-related thinking styles. Our findings emphasize the importance of studying positive, next to negative, affect in the context of depressive recurrence. A next research aim would be to find individual predictors of preventive treatment success.