Anxiety and anhedonia in depression: Associations with neuroticism and cognitive control.

Christian A Webb, Madhukar H Trivedi, Myrna M Weissman, Patrick J McGrath, Ramin V Parsey, Maurizio Fava, Benji T Kurian, Mary L Phillips, Diego A Pizzagalli, Daniel G Dillon, Allen Liao, Melvin G McInnis, Gerard E Bruder, Phil Adams, Bruce D Grannemann, Meredith A Shaw, Crystal Cooper, Thomas J Carmody, Robrina Walker

Journal: Journal of affective disorders 2019;245():1070-1078

PMID: 30699849

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Abstract

BACKGROUND

Despite the fact that higher levels of anxiety and anhedonia in Major Depressive Disorder (MDD) are linked to poorer treatment outcomes, mechanisms contributing to these clinical presentations remain unclear. Neuroticism, impaired cognitive control, and blunted reward learning may be critical processes involved in MDD and may help to explain symptoms of anxiety and anhedonia.

METHODS

Using baseline data from patients with early-onset MDD (N = 296) in the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) trial, we conducted a path analysis to model relationships between neuroticism, cognitive control, and reward learning to levels of anxiety and anhedonia.

RESULTS

Neuroticism was positively associated with both anhedonia (standardized coefficient = 0.26, p < .001) and anxiety (standardized coefficient = 0.40, p < .001). Cognitive control was negatively associated with anxiety (standardized coefficient = -0.18, p < .05). Reward learning was not significantly associated with either anxiety or anhedonia.

LIMITATIONS

Extraneous variables not included in the model may have even more influence in explaining symptoms of anxiety and anhedonia. Restricted range in these variables may have attenuated some of the hypothesized relationships. Most important, because this was a cross-sectional analysis in a currently depressed sample, we cannot draw any causal conclusions without experimental and longitudinal data.

CONCLUSIONS

These cross-sectional findings suggest that neuroticism may contribute to anxiety and anhedonia in patients with early onset and either chronic or recurrent MDD, while enhanced cognitive control may protect against anxiety.

Address: Spectrum CBT, Los Angeles, California, United States.; Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, United States.; VA North Texas Health Care System, Dallas, TX, United States.; Department of Psychiatry, Columbia University, United States.; Department of Psychiatry, University of Michigan, United States.; Department of Psychiatry, Harvard Medical School, United States.; University of Pittsburgh Medical Center, United States.; Department of Psychiatry, Stonybrook University School of Medicine, United States.; Mailman School of Public Health, Columbia University, United States.; Department of Psychiatry, Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, United States. Electronic address: [email protected].

DOI: 10.1016/j.jad.2018.11.072

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MeSH Terms: Adult, Anhedonia, Antidepressive Agents, Anxiety Disorders, Cognition, Cross-Sectional Studies, Depressive Disorder, Major, Female, Humans, Learning, Male, Middle Aged, Neuroticism, Reward, Treatment Outcome