New research published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging sheds light on decision-making and reward strategies and can help assess relapse vulnerability and promote sustained recovery and well-being

Philadelphia, May 1, 2025 – New research shows that individuals who have recovered from depression are generally less willing to exert effort to pursue potential rewards compared to those who have never experienced depression, unless the rewards are large and highly likely. A new study in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier, provides deeper insights into subtle motivational deficits that persist in individuals who have recovered from depression, potentially explaining relapse vulnerability and guiding targeted treatment for sustained recovery and overall patient well-being.

Individuals who have experienced depression in the past are often at a higher risk of experiencing another depressive episode. Despite improvements in mood after recovery from depression, they continue to exhibit some cognitive and motivational deficits, such as alterations in reward processing, impairing daily activities and functional recovery. The reasons behind this remain unclear. Researchers of the current study wanted to better understand the hidden processes in decision-making and motivation that might contribute to relapse vulnerability and identify ways to help people stay healthy after recovering from depression.

Lead investigator Diego A. Pizzagalli, PhD, formerly Center for Depression, Anxiety, and Stress Research, McLean Hospital (Belmont, MA) and Department of Psychiatry, Harvard Medical School, now Founding Director, Noel Drury, MD, Institute for Translational Depression Discoveries, Distinguished Professor, Department of Psychiatry and Human Behavior & Department of Neurobiology and Behavior, Noel Drury MD Endowed Chair, University of California at Irvine, says, ”Imagine an everyday scenario: deciding whether to meet a friend after work or simply stay home because going out feels too exhausting. Individuals with a history of depression might more often opt for the less effortful choice—staying home—missing out on rewarding experiences and social interactions. Over time, repeatedly choosing the low-effort path could unintentionally reinforce behaviors or thought patterns that increase the risk of falling back into depression."

The research entailed asking individuals who had previously experienced depression (but have recovered and are not currently using medication) and a group of participants who had never experienced depression to make a series of choices between low-effort tasks with smaller rewards and high-effort tasks with potentially larger rewards. Given evidence that antidepressants can blunt reward-related neural processes, only unmedicated individuals with remitted major depressive disorder were included to minimize potential confounding effects.

Choices were then analyzed using computational methods to understand motivation and decision-making. The most significant results showed that recovered individuals generally preferred less effortful options, but notably, they became equally or even more motivated than healthy individuals when rewards were large and highly certain. This suggests that while motivation may be reduced in everyday tasks, providing clear and highly valuable incentives can effectively boost motivation in individuals with a history of depression.

Editor-in-Chief of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging Cameron S. Carter, MD, University of California Irvine, notes, "Reduced motivation is a core feature of depression. Utilizing the Effort Expenditure for Rewards Task test, researchers examined how individuals weigh the potential benefits of rewards against the cognitive or physical effort required to obtain them, providing valuable insights into motivational processes underlying major depressive disorder. The findings from this study suggest a nuanced picture of decision-making in recovered depression, highlighting conditions under which motivation may actually surpass typical levels."

First author Manuel Kuhn, PhD, Center for Depression, Anxiety, and Stress Research, McLean Hospital (Belmont, MA) and Department of Psychiatry, Harvard Medical School, concludes, "This research is novel because it applies advanced computational modeling techniques, allowing us to identify latent decision-making processes—such as how reward magnitude and effort cost are integrated—that conventional analytical methods have not yet been able to uncover. This is particularly important now, as it provides deeper insights into subtle motivational deficits that persist in individuals who have recovered from depression, potentially explaining their vulnerability to relapse triggers. By pinpointing these underlying motivational mechanisms, our findings can inform the development of more targeted treatments designed to enhance sustained recovery and overall patient well-being."