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Cognitive emotional processing across mood disorders

  • Priyanka Panchal (a1) (a2), Alexander Kaltenboeck (a1) (a2) and Catherine J. Harmer (a1) (a2)


While impairments in cognitive emotional processing are key to the experience of mood disorders, little is understood of their shared and distinct features across major depressive disorder (MDD) and bipolar disorder (BD). In this review, we discuss the similarities and differences in abnormal emotional processing associated with mood disorders across the cognitive domains of perception, attention, memory, and reward processing, with a particular focus on how these impairments relate to the clinical profile of the disorders. We consider behavioral and neuroimaging evidence, especially that of the growing consensus surrounding mood-congruent biases in cognition, in combination with state- and trait-related characteristics in an attempt to provide a more comprehensive and translational overview of mood disorders. Special consideration is given to the shared phenomenon of mood instability and its role as a potential transdiagnostic marker across the prodrome and maintenance of mood disorders.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Address for correspondence: Professor Catherine Harmer, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. (Email:


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1. Mental disorders. World Health Organisation (WHO). 2017.
2. Harvard Medical School. National Comorbidity Survey ( NCS ). 2007.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
4. Roiser, J, Farmer, A, Lam, D, et al. The effect of positive mood induction on emotional processing in euthymic individuals with bipolar disorder and controls. Psychol Med. 2009; 39(5): 785791.
5. Vo, TM, Perry, P, Ellerby, M, Bohnert, K. Is lithium a neuroprotective agent? Ann Clin Psychiatry. 2015; 27(1): 4954.
6. 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.
7. Beck, AT. Depression. Clinical, experimental and theoretical aspects. J R Coll Gen Pract. 1969; 18(87): 249.
8. Dozois, DJA, Beck, AT. Cognitive schemas, beliefs and assumptions. In: Dobson KS, Dozois DJA, eds. Risk Factors in Depression. San Diego: Elsevier; 2008:119143.
9. Abramson, LY, Metalsky, G, Alloy, L. Hopelessness depression: a theory-based subtype of depression. Psychol Rev. 1989; 96(2): 358372.
10. Scheurich, A, Fellgiebel, A, Schermuly, I, Bauer, S, Wolfges, R, Muller, MJ. Experimental evidence for a motivational origin of cognitive impairment in major depression. Psychol Med. 2008; 38(2): 237246.
11. Roiser, J, Sahakian, BJ. Information Processing in Mood Disorders. In: DeRubeis RJ, Strunk DR, eds. The Oxford Handbook of Mood Disorders. Oxford University Press; 2016.
12. Pessoa, L, Adolphs, R. Emotion processing and the amygdala: from a “low road” to “many roads” of evaluating biological significance. Nat Rev Neurosci. 2010; 11(11): 773783.
13. Elliott, R, Zahn, R, Deakin, JFW, Anderson, IM. Affective cognition and its disruption in mood disorders. Neuropsychopharmacology. 2011; 36(1): 153182.
14. Christodoulou, T, Lewis, M, Ploubidis, GB, Frangou, S. The relationship of impulsivity to response inhibition and decision-making in remitted patients with bipolar disorder. Eur Psychiatry. 2006; 21(4): 270273.
15. Ghaemi, SN, Sachs, GS, Chiou, AM, Pandurangi, AK, Goodwin, K. Is bipolar disorder still underdiagnosed? Are antidepressants overutilized? J Affect Disord. 1999; 52(1–3): 135144.
16. Hirschfeld, RMA. The mood disorder questionnaire: its impact on the field [corrected]. Depress Anxiety. 2010; 27(7): 627630.
17. McGuffin, P, Katz, R. The genetics of depression and manic-depressive disorder. Br J Psychiatry. 1989; 155(3): 294304.
18. Harvey, PD. Cognitive impairments in major depression and bipolar disorders. Psychiatry (Edgmont). 2007; 4(1): 1214.
19. Insel, T, Cuthbert, B, Garvey, M, et al. Research Domain Criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010; 167(7): 748751.
20. Marwaha, S, Parsons, N, Flanagan, S, Broome, M. The prevalence and clinical associations of mood instability in adults living in England: results from the Adult Psychiatric Morbidity Survey 2007. Psychiatry Res. 2013; 205(3): 262268.
21. Henry, C, Mitropoulou, V, New, AS, Koenigsberg, HW, Silverman, J, Siever, LJ. Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. J Psychiatr Res. 2001; 35(6): 307312.
22. Gross, JJ, John, OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol. 2003; 85(2): 348362.
23. Ekman, P, Friesen, W V. Constants across cultures in the face and emotion. J Pers Soc Psychol. 1971; 17(2): 124129.
24. Beck, AT, Rush, J, Shaw, BF, Emery, G. Cognitive Therapy of Depression. 1st ed. Guildford Press; 1979.
25. Bradley, BP, Mogg, K, Lee, SC. Attentional biases for negative information in induced and naturally occurring dysphoria. Behav Res Ther. 1997; 35(10): 911927.
26. Gotlib, IH, Krasnoperova, E, Yue, DN, Joormann, J. Attentional biases for negative interpersonal stimuli in clinical depression. J Abnorm Psychol. 2004; 113(1): 127135.
27. Gotlib, IH, Kasch, KL, Traill, S, Joormann, J, Arnow, BA, Johnson, SL. Coherence and specificity of information-processing biases in depression and social phobia. J Abnorm Psychol. 2004; 113(3): 386398.
28. Joormann, J, Gotlib, IH. Selective attention to emotional faces following recovery from depression. J Abnorm Psychol. 2007; 116(1): 8085.
29. Duque, A, Vázquez, C. Double attention bias for positive and negative emotional faces in clinical depression: evidence from an eye-tracking study. J Behav Ther Exp Psychiatry. 2015; 46:107114.
30. Lembke, A, Ketter, TA. Impaired recognition of facial emotion in mania. Am J Psychiatry. 2002; 159(2): 302304.
31. Gray, J, Venn, H, Montagne, B, et al. Bipolar patients show mood-congruent biases in sensitivity to facial expressions of emotion when exhibiting depressed symptoms, but not when exhibiting manic symptoms. Cogn Neuropsychiatry. 2006; 11(6): 505520.
32. Harmer, CJ, Grayson, L, Goodwin, GM. Enhanced recognition of disgust in bipolar illness. Biol Psychiatry. 2002; 51(4): 298304.
33. Venn, HR, Gray, JM, Montagne, B, et al. Perception of facial expressions of emotion in bipolar disorder. Bipolar Disord. 2004; 6(4): 286293.
34. Vaskinn, A, Sundet, K, Friis, S, et al. The effect of gender on emotion perception in schizophrenia and bipolar disorder. Acta Psychiatr Scand. 2007; 116(4): 263270.
35. Martino, DJ, Strejilevich, SA, Fassi, G, Marengo, E, Igoa, A. Theory of mind and facial emotion recognition in euthymic bipolar I and bipolar II disorders. Psychiatry Res. 2011; 189(3): 379384.
36. Bilderbeck, AC, Atkinson, LZ, Geddes, JR, Goodwin, GM, Harmer, CJ. The effects of medication and current mood upon facial emotion recognition: findings from a large bipolar disorder cohort study. J Psychopharmacol. 2017; 31(3): 320326.
37. Murphy, FC, Sahakian, BJ, Rubinsztein, JS, et al. Emotional bias and inhibitory control processes in mania and depression. Psychol Med. 1999; 29(6): 13071321.
38. Erickson, K, Drevets, WC, Clark, L, et al. Mood-congruent bias in affective Go/No-Go performance of unmedicated patients with major depressive disorder. Am J Psychiatry. 2005; 162(11): 21712173.
39. Rubinsztein, JS, Michael, A, Paykel, ES, Sahakian, BJ. Cognitive impairment in remission in bipolar affective disorder. Psychol Med. 2000; 30(5): 10251036.
40. García-Blanco, AC, Perea, M, Livianos, L. Mood-congruent bias and attention shifts in the different episodes of bipolar disorder. Cogn Emot. 2013; 27(6): 11141121.
41. Kizilbash, AH, Vanderploeg, RD, Curtiss, G. The effects of depression and anxiety on memory performance. Arch Clin Neuropsychol. 2002; 17(1): 5767.
42. Bourne, C, Bilderbeck, A, Drennan, R, et al. Verbal learning impairment in euthymic bipolar disorder: BDI v BDII. J Affect Disord. 2015; 182:95100.
43. Sole, B, Bonnin, CM, Torrent, C, et al. Neurocognitive impairment across the bipolar spectrum. CNS Neurosci Ther. 2012; 18(3): 194200.
44. Bora, E, Yucel, M, Pantelis, C. Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. J Affect Disord. 2009; 113(1–2): 120.
45. Wolfe, J, Granholm, E, Butters, N, Saunders, E, Janowsky, D. Verbal memory deficits associated with major affective disorders: a comparison of unipolar and bipolar patients. J Affect Disord. 1987; 13(1): 8392.
46. Burt, T, Prudic, J, Peyser, S, Clark, J, Sackeim, H. Learning and memory in bipolar and unipolar major depression: effects of aging. Neuropsychiatry Neuropsychol Behav Neurol. 2000; 13(4): 246253.
47. Martínez-Arán, A, Vieta, E, Colom, F, et al. Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord. 2004; 6(3): 224232.
48. Mogg, K, Bradley, BP, Williams, R. Attentional bias in anxiety and depression: the role of awareness. Br J Clin Psychol. 1995; 34(Pt 1): 1736.
49. Harmer, CJ, O’Sullivan, U, Favaron, E, et al. Effect of acute antidepressant administration on negative affective bias in depressed patients. Am J Psychiatry. 2009; 166(10): 11781184.
50. Uher, R, Rutter, M. Basing psychiatric classification on scientific foundation: problems and prospects. Int Rev Psychiatry. 2012; 24(6): 591605.
51. 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.
52. Admon, R, Pizzagalli, DA. Dysfunctional reward processing in depression. Curr Opin Psychol. 2015; 4:114118.
53. Steele, JD, Kumar, P, Ebmeier, KP. Blunted response to feedback information in depressive illness. Brain. 2007; 130(9): 23672374.
54. Holmes, AJ, Pizzagalli, DA. Task feedback effects on conflict monitoring and executive control: relationship to subclinical measures of depression. Emotion. 2011; 7(1): 6876.
55. 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.
56. Eshel, N, Roiser, JP. Reward and punishment processing in depression. Biol Psychiatry. 2010; 68(2): 118124.
57. Roiser, JP, Cannon, DM, Gandhi, SK, et al. Hot and cold cognition in unmedicated depressed subjects with bipolar disorder. Bipolar Disord. 2009; 11(2): 178189.
58. Minassian, A, Paulus, MP, Perry, W. Increased sensitivity to error during decision-making in bipolar disorder patients with acute mania. J Affect Disord. 2004; 82(2): 203208.
59. Murphy, FC, Rubinsztein, JS, Michael, A, et al. Decision-making cognition in mania and depression. Psychol Med. 2001; 31(4): 679693.
60. Pizzagalli, DA, Goetz, E, Ostacher, M, Iosifescu, DV, Perlis, RH. Euthymic patients with bipolar disorder show decreased reward learning in a probabilistic reward task. Biol Psychiatry. 2008; 64(2): 162168.
61. Price, JL, Drevets, WC. Neural circuits underlying the pathophysiology of mood disorders. Trends Cogn Sci. 2012; 16(1): 6171.
62. Wagner, V, Müller, JL, Sommer, M, Klein, HE, Hajak, G. [Changes in the emotional processing in depressive patients: a study with functional magnetoresonance tomography under the employment of pictures with affective contents]. Psychiatr Prax. 2004; 31(Suppl 1): S7072.
63. Price, JL, Drevets, WC. Neurocircuitry of mood disorders. Neuropsychopharmacology. 2010; 35(1): 192216.
64. Anand, A, Li, Y, Wang, Y, et al. Activity and connectivity of brain mood regulating circuit in depression: a functional magnetic resonance study. Biol Psychiatry. 2005; 57(10): 10791088.
65. Lee, BT, Seok, JH, Lee, BC, et al. Neural correlates of affective processing in response to sad and angry facial stimuli in patients with major depressive disorder. Prog Neuro-Psychopharmacology Biol Psychiatry. 2008; 32(3): 778785.
66. Gotlib, IH, Sivers, H, Gabrieli, JDE, et al. Subgenual anterior cingulate activation to valenced emotional stimuli in major depression. Neuroreport. 2005; 16(16): 17311734.
67. Roberson-Nay, R, McClure, EB, Monk, CS, et al. Increased amygdala activity during successful memory encoding in adolescent major depressive disorder: an FMRI study. Biol Psychiatry. 2006; 60(9): 966973.
68. Hamilton, JP, Gotlib, IH. Neural substrates of increased memory sensitivity for negative stimuli in major depression. Biol Psychiatry. 2008; 63(12): 11551162.
69. Delvecchio, G, Fossati, P, Boyer, P, et al. Common and distinct neural correlates of emotional processing in bipolar disorder and major depressive disorder: a voxel-based meta-analysis of functional magnetic resonance imaging studies. Eur Neuropsychopharmacol. 2012; 22(2): 100113.
70. Cerullo, MA, Adler, CM, Delbello, MP, Strakowski, SM. The functional neuroanatomy of bipolar disorder. Int Rev Psychiatry. 2009; 21(4): 314322.
71. Chen, CH, Lennox, B, Jacob, R, et al. Explicit and implicit facial affect recognition in manic and depressed states of bipolar disorder: a functional magnetic resonance imaging study. Biol Psychiatry. 2006; 59(1): 3139.
72. Rottenberg, J, Gross, JJ, Gotlib, IH. Emotion context insensitivity in major depressive disorder. J Abnorm Psychol. 2005; 114(4): 627639.
73. Treadway, MT, Zald, DH. Reconsidering anhedonia in depression: lessons from translational neuroscience. Neurosci Biobehav Rev. 2010; 35(3): 537555.
74. Abler, B, Greenhouse, I, Ongur, D, Walter, H, Heckers, S. Abnormal reward system activation in mania. Neuropsychopharmacology. 2008; 33(9): 22172227.
75. Strakowski, SM, Delbello, MP, Adler, CM. The functional neuroanatomy of bipolar disorder: a review of neuroimaging findings. Mol Psychiatry. 2005; 10(1): 105116.
76. Strakowski, SM, Adler, CM, DelBello, MP. Volumetric MRI studies of mood disorders: do they distinguish unipolar and bipolar disorder? Bipolar Disord. 2002; 4(2): 8088.
77. Hwang, J, Lyoo, IK, Dager, SR, et al. Basal ganglia shape alterations in bipolar disorder. Am J Psychiatry. 2006; 163(2): 276285.
78. Broome, MR, Saunders, KEA, Harrison, PJ, Marwaha, S. Mood instability: significance, definition and measurement. Br J Psychiatry. 2015; 207(4): 283285.
79. Eldar, E, Niv, Y. Interaction between emotional state and learning underlies mood instability. Nat Commun. 2015; 6:6149.
80. Eldar, E, Rutledge, RB, Dolan, RJ, Niv, Y. Mood as representation of momentum. Trends Cogn Sci. 2016; 20(1): 1524.
81. Broome, MR, He, Z, Iftikhar, M, Eyden, J, Marwaha, S. Neurobiological and behavioural studies of affective instability in clinical populations: a systematic review. Neurosci Biobehav Rev. 2015; 51:243254.
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