When I was working in an outpatient neuropsychology clinic at a hospital, I had completed a neuropsychological evaluation with a middle-aged woman who was concerned about memory problems. Her testing indicated that cognitively she was relatively intact with some mild difficulties likely related to the effect that her depression was having on her sense of cognitive efficiency in day-to-day life. During our meeting to review the results of her testing, she commented that she wished I would have told her she “had a hole in her brain” so that her family would better understand her struggles. This conversation has stuck with me because, all too often, I evaluate individuals who appear disappointed when they “only” have depression or anxiety that is contributing to daily cognitive concerns. I think this speaks to the ongoing stigma around mental health and the lack of understanding that psychiatric diagnoses like depression and anxiety also have a very neurobiological basis. Much like I ended up discussing with my patient, depression and anxiety have been well researched and clearly impact cognition. There are multiple subtypes of depression and anxiety that can present differently, but from a cognitive standpoint there are some clear indications.
- Depression symptoms can include some or all of the following: feelings of helplessness, hopelessness, worthlessness; tiredness/fatigue, low motivation; sadness; poor self-esteem; and sleep disturbance (insomnia, over sleeping). Symptoms can negatively affect relationships, work, and daily functioning.
- Typically, the more severe the depression symptoms the more severe the cognitive difficulty. The most common cognitive concerns are memory and concentration, although slowed processing speed and executive functioning problems (i.e., problem solving, cognitive flexibility) are also reported. Memory problems often include poor free recall of material, but when provided with prompts or “cues,” the individual is able to perform better.
- Typically, with treatment of the depression symptoms, cognitive difficulties improve. Impairments in executive functioning (especially initiation and perseveration), have been linked with poorer outcomes in depression and may linger.
- Evidence-based treatment typically includes therapy and/or medication.
- Anxiety symptoms can present in a multitude of ways, but some common symptoms include activation of the nervous system (e.g., increased heart rate, changes in breathing, stomach problems, etc.) and can involve a cognitive component (e.g., worry, anxious thoughts). One of the more common anxiety disorders is Generalized Anxiety Disorder, which can include intense feelings of nervousness occurring in broad situations, cognitive symptoms of worrying, and feeling “keyed up” or on edge. These symptoms also can impact daily life and functioning (relationships, work, etc.)
- Cognitive effects tend to be broad, although not global, and are most commonly seen in areas of memory, executive functioning, and working memory. In older adults, there can be deficits in processing speed.
- With successful treatment, cognition typically improves. Evidence-based treatment includes therapy and/or medication.
For both depression and anxiety, there can be genetic contributions, and often neurotransmitters (i.e., brain chemicals) are impacted and likely contribute to the cognitive difficulties that individuals experience. Both medication and therapy assist with regulation of these chemicals. A majority of individuals experience improvement in symptoms from these treatments, and some people find relief from symptoms with good response to treatment.
Getz, G. (2014). Applied Biological Psychology. Springer Publishing Company,