Cognitive flexibility and depression remission: A narrative review

Area of Science:

• Cognitive Neuroscience
• Psychiatry
• Neuroscience

Background:

• Cognitive flexibility is frequently impaired in depression, contributing to rigid thinking and treatment resistance.
• Approximately 50% of patients do not respond to initial antidepressant therapies, often due to residual rigid cognitive schemas.
• Understanding cognitive flexibility's role is crucial for improving depression remission rates.

Purpose of the Study:

• To explore the relationship between depression, cognitive flexibility, and remission using a cognitive neuroscience perspective.
• To review literature linking cognitive functions, homeostasis, and allostasis in the context of depression.

Main Methods:

• A narrative literature review was conducted.
• Searches were performed on PubMed using keywords: "depression", "cognitive flexibility", "cognitive functions", "homeostasis", and "allostasis".

Main Results:

• Depression is conceptualized as a homeostatic imbalance disrupting allostatic mechanisms necessary for cognitive and neural remission.
• Neural findings indicate imbalanced functional connectivity between the default mode network (DMN), salience network (SN), and central executive network (CEN).
• Hyperactivation of the DMN and disconnection of the SN impede CEN activation, preventing the implementation of allostatic mechanisms for homeostasis and remission.

Conclusions:

• A balanced functional connectivity between brain networks promotes cognitive flexibility.
• Cognitive flexibility facilitates the use of allostatic cognitive resources like attentional control and adaptive appraisal.
• These processes are essential for achieving functional remission in depression.