Impaired flexible decision-making in Major Depressive Disorder

J Affect Disord. 2010 Jul;124(1-2):207-10. doi: 10.1016/j.jad.2009.11.013. Epub 2009 Dec 9.


Background: Depression is associated with dysfunctional affective states, neuropsychological impairment and altered sensitivity to reward and punishment. These impairments can influence complex decision-making in changing environments.

Methods: The contingency shifting variant Iowa Gambling Task (IGT) was used to assess flexible decision-making performance in a group of medicated unipolar Major Depressive Disorder (MDD) patients (n=19) and a group of healthy control volunteers (n=20). The task comprised the standard IGT followed by a contingency-shift phase where decks progressively changed reward and punishment schedule.

Results: Patients with MDD showed impaired performance compared to controls during both the standard and the contingency-shift phases of the IGT. Analysis of the contingency-shift phase demonstrated that individuals with depression had difficulties perceiving when a previously bad contingency became good.

Limitations: The present findings have several limitations including small sample size, the possible confounding role of medication and absence of other neuropsychological tests (i.e., executive function).

Conclusion: Depressed patients show impaired decision-making behaviour in static and dynamic environments. Altered sensitivity to reward and punishment is proposed as the mechanism responsible for the lack of advantageous choices and poor adjustment to a changing environment.

MeSH terms

  • Adult
  • Antidepressive Agents / therapeutic use
  • Attention / drug effects
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / drug therapy
  • Cognition Disorders / psychology
  • Decision Making* / drug effects
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / psychology
  • Drug Therapy, Combination
  • Female
  • Gambling / psychology
  • Humans
  • Lithium Carbonate / therapeutic use
  • Male
  • Middle Aged
  • Neuropsychological Tests / statistics & numerical data
  • Psychometrics
  • Punishment
  • Reference Values
  • Reward


  • Antidepressive Agents
  • Lithium Carbonate