Executive Dysfunction And Depression: Causes, Mental Health Impact, And Treatment
Executive functioning generally refers to mental processes such as working memory, cognitive flexibility, and self-regulation, which enable us to perform fundamental tasks in our day-to-day lives.
Experiencing executive dysfunction symptoms may be a cause for concern and may impact a person’s ability to complete tasks. Executive dysfunction can be linked to many different conditions or illnesses, including mental health conditions like depression. Read on to learn how to recognize signs of executive function deficits and how they may be related to your mental health.
Executive functioning and problem-solving in brain development
Executive functioning refers to the skills that are involved in a wide variety of daily tasks, such as time management and completing tasks. Executive functioning skills can be split into two types: those used for organization and those used for regulation. Organizational functions include attention, planning, verbal working memory, problem solving, and flexible thinking, which are crucial as higher-level executive functions. Regulatory functions involve monitoring internal and external stimuli, exercising self-control, emotional regulation, moral reasoning, and decision-making as it relates to time, money, and other areas of management.
These functions develop from around two years of age in one’s brain (specifically memory-related areas) and are usually fully formed by 30. However, there are individual differences in the rate of this development, which can affect how executive functions develop in adults. Each function plays a crucial role in everyday life, which is why deficits in executive functioning can be challenging or even debilitating, depending on the severity of the issue. Problem-solving plays a key role in executive functioning, relying on skills like planning and flexible thinking. As these abilities develop, they support brain maturation and complex decision-making.
Examples of difficulties with executive functioning
Experiencing executive dysfunction means having difficulty with any of the abilities listed above. Signs of executive dysfunction can include:
- Trouble shifting attention from one task to the next (such as you may see in those who live with attention deficit disorder)
- Getting distracted easily or having trouble focusing on complex tasks
- Working memory deficits
- Frequently daydreaming during conversations at work or school
- Difficulty with self-motivation (which can be commonly associated with conditions such as executive function disorder)
- Trouble organizing or planning ahead, perhaps showing up as poor time management skills
- Focusing too much on one thing, as executive function skills may be required to switch between priorities
- Frequently misplacing school materials or items, which can be associated with a limited or divergent working memory
- Experiencing problems with impulse control (snacking when trying to stick to a diet, blurting out thoughts you didn’t mean to, having inappropriate emotional reactions, or struggling to regulate emotions)
Executive dysfunction disorder
Common causes of executive dysfunction
According to the British Medical Bulletin, executive dysfunction can have or be linked to a variety of different causes, including:
- Traumatic brain injury
- Toxins (such as carbon monoxide poisoning)
- Vitamin deficiencies
- Alzheimer’s or dementia
- Epilepsy
- Substance use disorders
- Bipolar disorder
- Schizophrenia
- Obsessive-compulsive disorder (OCD)
- Anxiety disorders
- Depression
If you are struggling with substance use, contact the SAMHSA National Helpline at 1-800-662-HELP (4357) to receive support and resources. Support is available 24/7.
Brain damage, executive dysfunction, and treatment
In general, executive dysfunction is related to damage to or deterioration of some parts of the brain. It can also range widely in severity and duration, or frequency based on the main cause.
Various tools and self-tests can provide valuable insights into an individual’s executive functioning abilities and help clinicians develop a treatment plan, which may include cognitive therapy, medication, or lifestyle modifications. Additionally, these assessments can be repeated over time to chart progress or determine if any changes need to be made to the plan.
Problem-solving and executive dysfunction assessment tools
To assess the individual’s executive function, clinicians may use a variety of tools, such as the Behavior Rating Inventory of Executive Functioning (BRIEF) and the Comprehensive Executive Function Inventory (CEFI). The BRIEF is administered as an interview or self-report questionnaire that provides information about behavior regulation, emotional control, and problem-solving skills, while the CEFI is a performance-based assessment that measures executive functioning in areas such as cognitive flexibility and self-regulation. Since problem-solving is a key component of executive function, these assessments help identify difficulties in planning, decision-making, and adapting to new challenges.
The Barkley Deficits in Executive Functioning Scale (BDEFS), Montreal Cognitive Assessment (MoCA), and Stroop color and word test are other tools that can help measure executive dysfunction. They provide both qualitative and quantitative information about an individual’s cognitive skills.
Understanding executive dysfunction and depression
Isolating the exact cause of executive dysfunction can be challenging in some behavioral therapy cases. There are many possible contributing factors, and some can be congenital or undiagnosed, making the main source of executive dysfunction harder to isolate. However, a brief review of research does show that those who have depression or people with ADHD are likely to experience some level of executive dysfunction as a symptom, which might be linked to the prefrontal cortex.
What is depression?
- Loss of interest in previously enjoyed activities
- Significant fluctuations in appetite or weight
- Significant fluctuations in sleep
- Problems with planning or completing goal-directed activities
- Lack of energy
- Feelings of worthlessness, hopelessness, or guilt
- Trouble thinking or making decisions
As you can see, some of the symptoms of depression, such as working memory difficulties or sleep problems, overlap with executive dysfunction symptoms. However, that doesn’t mean that someone experiencing executive dysfunction has depression. There can be other factors at play, such as anxiety symptoms, as outlined in a previous section. That’s why a mental health professional would need to take an overview of your situation and learn more about what you’re feeling to decide if depression or depressed mood may be the root cause.
Executive dysfunction and depression
If you've noticed the symptoms of executive dysfunction manifesting in your daily life and you've noticed some symptoms of depression as well, there may be a link. Speaking with a medical professional or a therapist can be a helpful first step in determining the underlying cause of executive dysfunction and exploring potential treatment options if the cause is mental-health related.
Mental health treatment options for depression
Online therapy
Studies have shown online cognitive behavioral therapy (CBT) to actually be slightly more effective in treating certain mental illnesses than the face-to-face modality, though both are recognized as valid treatments. One literature review of 17 studies on the topic, likely including experimental psychology research, suggests that online CBT is more effective than traditional, in-person therapy for reducing symptoms of depression, specifically. It also notes that virtual CBT can be less expensive than in-person therapy. CBT may also help with executive dysfunction.
If you’re interested in trying online therapy, consider a platform like BetterHelp. After filling out a brief questionnaire, you can get matched with a licensed mental health professional who suits your needs and preferences. If you prefer face-to-face therapy, you can search for providers who are located near you and specialize in the areas in which you need support, such as interference control. Regardless of the format you choose, a therapist can help you manage symptoms of depression or executive dysfunction.
Takeaway
Is procrastination an issue in executive functioning?
Yes, procrastination can stem from issues with executive functioning. Difficulties in executive function deficits, such as planning, organizing, and self-motivation, often make it hard to start and complete tasks on time. Challenges with cognitive processes and working memory may also be part of it, making it difficult for someone to prioritize tasks and concentrate. Under certain situations, procrastination may be more common among those who are experiencing depressive symptoms or major depressive disorder. Task initiation and completion may also be affected by reduced motivation and depressed mood.
Research has shown that executive impairment and difficulties in cognitive tasks may affect everyday life and the overall productivity of a person. According to findings in the Diagnostic and Statistical Manual of Mental Disorders, impairments in executive control and cognitive functioning are primary features in many mental disorders, including affective disorders. Identifying and addressing these challenges early with the guidance of a professional healthcare provider may help improve symptoms and enhance quality of life.
Are there behaviors or disorders that can make executive dysfunction worse?
Yes. Disorders such as depression or major depressive disorder, anxiety and anxiety symptoms, ADHD, and even neurological conditions like dementia and brain or frontal lobe injuries can exacerbate executive function challenges. Behaviors like poor impulse control and difficulty shifting or paying attention can also worsen these issues. People with depressive symptoms or severe depression may encounter greater executive function problems, often linked to changes in cognitive processes and overall cognitive functioning.
Studies using behavior rating inventory tools and structured clinical interview methods have shown that negative affect, depressed mood, and motivational impairments are common risk factors for declining executive control. Research suggests that executive impairment may vary depending on individual differences and often correlates with information processing deficits and memory impairments in people diagnosed with mental disorders.
What are the mental health exercises that can help improve executive dysfunction?
Exercises based on cognitive-behavioral techniques can be an effective form of treatment for improving executive function. These include activities that focus on problem-solving skills, self-monitoring, and emotional regulation. Regular practice in planning, setting goals, and using structured cognitive tasks can help strengthen executive functions over time. For some individuals with major depressive disorder or affective disorders, strengthening working memory and improving cognitive functioning can address executive impairment linked to depression severity.
Techniques grounded in cognitive remediation therapy and insights from previous research and meta-analysis suggest that targeting negative mood, depressed mood, and negative affect can support improvements in cognitive performance. Addressing sleep problems, trait anxiety, and building resilience in daily life activities may also be recommended, as executive function refers to skills which can be important for managing emotions and behavior effectively. Findings from laboratory measures and present study designs may show that even small improvements in mental sets and coping with symptoms of depression can make a significant difference.
Can depression cause executive function disorder?
Depression is closely linked to executive dysfunction. Many people with depression or major depressive disorder experience issues with working memory, decision-making, planning, and impulse control, which suggests that depression can contribute significantly to executive impairment or problems with executive functions.
In individuals with major depressive disorder, changes in executive function can be easily noticed. They might find it difficult to arrange schedules and manage simple tasks day-to-day because of trouble with working memory. Studies using latent variable analysis and other data analysis methods have shown that depressed mood, negative affect, and severe symptoms often go hand-in-hand with cognitive struggles. Research from the present study and past meta-analysis suggests that sleep problems and individual differences also play a role. Even though few studies have fully captured every study concept, the present results highlight how depression can affect executive function in many different aspects of life. Understanding this connection is important when looking at symptoms of depression and planning effective treatments.
Can emotional trauma cause executive dysfunction?
Emotional trauma may lead to executive dysfunction by affecting different parts of the brain responsible for attention and focus, decision-making, and working memory. It may also cause anxiety symptoms, depressed mood, and other affective disorders, which may worsen executive function problems. Meta-analysis and some present study findings suggest that trauma-related symptoms are linked to difficulties in thinking clearly and staying organized.
Do antidepressants help with executive dysfunction?
Yes, antidepressants can sometimes help with executive dysfunction. They may help improve depressed mood and lower anxiety symptoms. This may make it easier for individuals to think clearly and use their working memory. One meta-analysis shows that they may help with certain symptoms, but the results can be different for each individual. There are cases suggesting that they may also improve sleep, which could also support brain function. The improvements in executive function may depend on the type of depression, the medication used, and different aspects of a person’s mental health.
What is the best treatment for executive dysfunction?
The best treatment for executive dysfunction may depend on the main underlying cause of it. For an individual who has major depressive disorder or affective disorders, therapy may be a good treatment as it addresses depression severity and depressed mood. Medication may also be an important factor here. To improve executive impairment, overall cognitive functioning and treatments that target working memory may help.
Cognitive-behavioral therapy or CBT and cognitive training exercises, backed by meta-analysis and latent variable analysis, show promise in enhancing cognitive performance. Research based on the statistical manual or DSM-IV criteria highlights that individual differences in daily life activities and negative affect can influence the success of interventions. Addressing sleep problems as early as possible, which are often noted in the present study findings, may also be important to lower the possible increased risk of repeated episodes of dysfunction. Although few studies have explored every study concept around executive dysfunction, data analysis and descriptive statistics from recent trials emphasize that treating symptoms like mental sets and understanding the factor structure of executive tasks may possibly lead to better outcomes in managing depression and related impairments.
What makes executive dysfunction worse?
Several factors can make executive dysfunction worse. Major depressive disorder, anxiety symptoms, and other affective disorders may often interfere with executive function and cognitive processes. Research has shown that depressive symptoms, negative mood, and depressed mood can reduce executive control, leading to an impaired ability to plan, organize, and complete tasks. Studies using behavior rating inventory assessments and structured clinical interview methods demonstrate that executive impairment tends to worsen with sleep problems, repeated episodes of depression, and chronic stress.
According to previous research and a meta-analysis, impairments in working memory, cognitive performance, and frontal lobe functioning are common in individuals with depression. Trait anxiety and individual differences may also be part of some factors, and obvious symptoms may vary depending on the severity measured through descriptive statistics and data analysis. Understanding these possible risk factors and their clinical implications can be important for developing effective cognitive therapy interventions.
- Previous Article
- Next Article