ELSEVIER

Journal of Affective Disorders 35 (1995) l-9

AFFECTIVE DISORDERS

JOURNAL

OF

Research report

An analysis of memory dysfunction in major depression

J.E. Ilsley, A.P.R. Moffoot, R.E. OCarroll
*
MRC Brain Metabolism Unit, Royal Edinburgh Hospital, Morningside Park, Edinburgh EHIO 5HF, UK

Received 24 June 1994; revised 27 February 1995; accepted 27 February 1995

Abstract
15 patients suffering from DSM-III-R major depression were compared with 15 age-, sex-and intelligence-matched controls on a battery of memory tests, aimed at fractionating memory dysfunction in depression. Patients were unimpaired relative to controls on measures of short-term memory, recognition, semantic memory and implicit memory. There was no evidence of a hedonic bias in recall of positive vs. negatively valenced stimuli, nor was there any correlation between depression severity and level of memory impairment. Psychotic patients did not demonstrate greater memory impairment relative to nonpsychotic depressed patients. As a group, however, depressed patients demonstrated deficits in psychomotor speed and in free recall of material (both immediate and delayed). The selective recall deficit suggests that material has been encoded but that patients are particularly impaired with regard to search and retrieval processes.
Keywords: Neuropsychology; Cognitive; Executive; Implicit; Explicit; Semantic; Hedonic bias

1. Introduction

Until relatively recently, it was believed that even severe depression was associated with only minor impairment in cognitive function and, in fact, the differential diagnosis of major depression from dementia of the Alzheimer-type rested largely on this belief. However, recent research has clearly established that memory functioning appears to be impaired in major depression (see review by Robbins et al., 1992) and this is not simply attributable to reductions in motivation (Richards and Ruff, 1989). Memory, however, is not a unitary function and the aim of the current investigation was to attempt a

detailed fractionation of different aspects of memory dysfunction in major depression in an effort to characterize which aspects of mnemonic function are selectively affected in major depression. We employed currently accepted theoretical divisions into short-and long-term, episodic and semantic, explicit and implicit memory, and positive and negative hedonic bias. Many previous studies have suffered from a limited focus on a particular aspect of memory functioning and many have been analogue studies, using healthy subjects following mood induction techniques or undergraduates who have scored highly on the Beck depression inventory (Beck et al., 1961).
1.1. Short-term memory

Corresponding author.

Short-term memory acts as a temporary store for newly registered information, has a limited capacity

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and holds information for up to 30 s at a time. The subjective complaint by depressives of poor concentration/short-term memory most distinguishes them from amnesics (Squire and Zouzounis, 1988). Paradoxically, when short-term memory is actually measured, most commonly using forward digit span, the majority of studies fail to find any impairment in depressives performance (e.g., Austin et al., 1992; Channon et al., 1993; Dean et al., 1987; Glass et al., 1981; Richards and Ruff, 1989; Rush et al., 1983). 1.2. Long-term memory In contrast to short-term memory, long-term memory has a very large capacity and holds memories which were acquired a few minutes ago, to those registered decades ago. The majority of studies that have been carried out in depression have found evidence of impaired recall and recognition for both verbal and visuo-spatial material when there is an interval of minutes or hours between the presentation and memory test (Austin et al., 1992; Brand et al., 1992; Caine et al., 1984; Golinkoff and Sweeney, 1989; Stemberg and Jarvik, 1976; Wolfe et al., 1987). 1.3. Semantic memory Whereas episodic/declarative memory refers to the ability to remember personally experienced events, semantic memory, on the other hand, relates to conceptual knowledge about the real world and is defined by terms, such as facts, rules and concepts, e.g., knowing that a dog is mammal. Relatively little research has been carried out focusing on semantic memory dysfunction in major depression, in contrast to recent work suggesting a selective deficit in semantic memory functioning in another functional disorder, schizophrenia (Duffy and OCarroll, 1994; Tamlyn et al., 1992). Some studies have used verbal fluency to assess semantic memory and the majority have claimed normal performance in both medicated and unmedicated depressed patients (Austin et al., 1992; Flor-Henry and Yeudall, 1979; Johnson and Crockett, 1982; Wolfe et al., 1987) although Caine et al. (1984) did report poor performance in depressed patients. Calev et al. (1989) contrasted verbal fluency to letter (M) vs. fluency to category (animals) and reported that depressed pa-

tients had a greater difficulty in producing responses to semantic category than when prompted by letter, which was in contrast to age-matched normal controls who showed the opposite pattern. Calev et al. (1989) concluded that depressives had a specific deficit in retrieving information meaningfully organized in their semantic memory. McKenna (1991) attempted to bridge a link between putative dysfunctional semantic memory and clinical symtomatology and proposed that faulty beliefs (delusions) could be equated with the concept of dysfunctional semantic memory, i.e., that delusions consisted of an inappropriate laying down of new semantic memories. This leads on to the specific prediction that psychotic/deluded depressives will have dysfunctional semantic memory systems. 1.4. Implicit memory Implicit memory is demonstrated when previous information that the subject has been exposed to influences ongoing responses, even when the subjects cannot recall the information or episode itself. For example, after studying a list of words containing the word dependent, a subject is more likely to subsequently complete the word stem dep ... with dependent when requested to complete the word stem with the first word that comes to mind. Amnesic patients are impaired relative to controls on free recall and recognition memory tests (explicit memory) as would be predicted but showed normal performance on word-fragment completion (implicit memory) (Graf et al., 1984). Five out of six studies have demonstrated that, while depressed subjects perform poorly on explicit tasks (free recall, cued recall and recognition), no such impairment on the implicit tasks (word-fragment and word-stem completion) was observed (Bazin et al., 1994; Danion et al., 1991; Denny and Hunt, 1992; Hertel and Hardin, 1990; Watkins et al., 1992). The one exception, a study by Elliott and Greene (19921, found that depressed subjects were impaired on both explicit and implicit memory tasks. 1.5. Hedonic bias A variety of studies have been carried out demonstrating that depressed patients have a tendency to

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selectively recall negative material. For example, Breslow et al. (1981) demonstrated that, when subjects were required to recall a short story containing a mixture of positive, neutral and negative themes, depressed subjects recalled 20% fewer positive themes than nondepressed subjects. Lloyd and Lishman (1975) also demonstrated that speed of recall of unpleasant events is also strongly related to depression severity. Williams et al. (1988) proposed that cognitive processing occurs in 2 stages, the preattentive and the elaboration stages. The preattentive stage allows attentional capture of information and is reflected in implicit memory tests whereas the elaboration stage involves the association of target information with other information in memory, and is reflected in explicit tests. If implicit memory is unaffected in depression, one would predict a mood congruent memory bias in depression to be reflected in explicit but not implicit memory tasks. In line with this prediction, Denny and Hunt (1992) and Watkins et al. (1992) have demonstrated that depressed subjects recall significantly more negatively valenced words than positively valenced words on explicit memory tasks but no such bias was evident on implicit memory measures. However, in reviewing these studies, Roediger and McDermott (1992) suggested that an effect, albeit nonsignificant, was present in that there was a 2-4% advantage for controls on positive words and a 4-6% advantage on depression-related words for depressed subjects. Therefore, the evidence to date regarding hedonic bias and explicit/implicit memory is inconclusive. The hypotheses of the present study can be summarised as follows. 1. Depressed subjects will show no impairment on short-term memory tasks. 2. Depressed patients will demonstrate significant impairment in long-term episodic memory. 3. Measures of semantic memory will be largely intact in depression, however, a selective impairment on fluency by category may be observed. 4. Depressed subjects with psychotic features will be impaired on semantic memory tasks. 5. Depressed subjects will show a selective impairment in explicit memory but not in implicit memory. 6. Hedonic bias affecting explicit recall will be demonstrated in depressed patients, i.e., depressed

patients will preferentially recall negatively valenced material in explicit tasks, with more severely depressed patients demonstrating the strongest hedonic bias. No such mood-congruent memory bias will be present in implicit memory tasks.

2. Methods 2 groups of 15 depressed patients and 15 matched controls were recruited for the present study. The depressed group consisted of individuals meeting the DSM-III-R criteria for major depressive disorder. Patients were recruited from the inpatient wards and day unit at the Royal Edinburgh Hospital, Edinburgh, UK. Patients were excluded if there was a history of organic brain disease, alcohol or drug abuse, or had been treated with ECT within the previous 6 months. 11 subjects were taking antidepressant medication and 4 subjects were unmedicated. Mean severity of depression as assessed using the 21-item Hamilton depression rating scale (Hamilton, 1960) was 26.4 (SD = 5.9, range = 18-40) and Beck depression inventory (Beck et al., 1961) 32.7 (SD = 8.7, range = 21-47), indicating that the sample were severely depressed. The control group was recruited from hospital staff and volunteer staff from the community. There were no significant betweengroup differences in age (depressed mean (SD) = 47.3 (16.2), control=43.6 (12.3), F=0.49, P= 0.49), NART IQ (D = 104.9 (lO.l), C = 106.9 (13.7) F = 0.19, P = 0.66), SEX (D = 9M,6F, C = llM,4F, x2 = 0.6, P = 0.44) or handedness (D = 12R,3L, C = 12R,3L, x2 = 0, P = 1.00). 2.1. Procedure All subjects were administered the battery of neuropsychological measures and rated for depression severity post-test administration. Assessments were carried out by the principal author in a single session lasting N 75 min. The depression rating scales were administered after the cognitive assessments to ensure that responses on the explicit/implicit measures were not influenced by the administration. To reduce the possibility of contamination, no subtests assessing memory were presented between the explicit and implicit measures.

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2.2. Measures General cognitive function The mini-mental state examination (MMSE; Folstein et al., 1975) was employed as a brief global cognitive screening test, to detect the presence of significant generalized cognitive impairment. The national adult reading test (revised) (NART-R; Nelson and Willison, 1991) was used to provide an estimate of premorbid intellectual level. Performance on the NART-R has been shown to be unaffected in major depression (Crawford et al., 1987). Short-term memory The digit span subtests from the Wechsler memory scale (revised) (Wechsler, 1987) were employed as measures of short-term or working memory. Episodic/declarative memory The Rivermead behavioural memory test (RBMT; Wilson et al., 1985; Wilson et al., 1989) was employed as an ecologically valid measure that provides an objective assessment of a variety of aspects of everyday memory functioning and correlates with observer ratings (Wilson et al., 1989). Semantic memory ,+f, Following Calev et al. (1989), 2 forms of an oral verbal fluency task were administered. The first required a response to a letter prompt (m) the other to a semantic category (animal). The subject had to produce as many words as possible in response to the prompt within 1 min. In addition, the silly sentences test (Collins and Quillian, 1969) was employed as a measure of semantic memory. This test consists of 50 statements, such as bishops wear clothes and prime ministers have feathers. Subjects were required to classify these statements as true or false. Following Tamlyn et al. (1992) and Duffy and OCarroll (19941, the statements were read allowed and the subject responded verbally. The number of errors made and time taken to respond are recorded and both are taken as measures of the integrity of semantic memory. Healthy controls rarely make errors, however, patients with schizophrenia demonstrate a high error rate and a slowed rate of responding (D&y and OCarroll, 1994; Tamlyn et al., 1992).

Implicit learning and subsequent recall 2 lists of 12 words were matched on the basis on their length and frequency of occurrence in written text (using the norms provided by Francis and Kucera, 1982). The valence of the words was judged by having 10 independent raters rate the words either positive or negative, with 100% agreement. Words were divided so that each list contained 6 positive and 6 negative words. All words had 3-or 4-letter word stems that were unique in this list and for each word there was at least 1 other word (not used in this study) that shared its 3 or 4 letter stem and was higher in word frequency. The experimental 1Zword list was presented to the subjects and used in the implicit and explicit task (unlucky, trusting, fatigued, assertive, withdrawn, respected, optimistic, miserable, inferior, contented, lonely, exciting). The other list acted as a control and was not presented to the subjects and was merely used to assess baseline performance, that is, number of word stems subsequently correctly completed without prior exposure (numbness, amiable, insecure, amenable, oppressed, courageous, confident, depressed, inactive, motivated, guilty, grateful). The difference between the number of word stems correctly completed on the 2 tasks (experimental list minus control list) was used as a measure of priming. Following Denny and Hunt (19921, the subjects were given a self-rating task and asked to evaluate the 12 words in the experimental list as to how well the word describes you, or is consistent with what is happening in your life right now. The words were pseudorandomized so there was no more than 2 word stems of the same affective valence presented in order. A 7-point Likert scale was used ranging from totally to not at all. Subjects were not informed that memory for the self-rating items would subsequently be tested and no time limit was given. In assessing implicit memory, 24 word stems (stems from the 12 words from the experimental list and 12 stems from the control list) were presented and the subjects were instructed to complete the word stems with the first word that came to mind, excluding proper nouns. There was no time limit and subjects were encouraged to complete all the stems. Subjects were subsequently given a cued recall task that consisted of 12 word stems from the experimental list only, which were used in the self-rating task. Subjects were instructed to complete

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the stem with words they had seen in the previous rating task. There was no time limit and subjects were encouraged to complete all the stems.
Psychomotor speed

The digit symbol substitution test (DSST) from the Wechsler adult intelligence scale (revised) (WAIS-R, Wechsler, 1981), a paper-and-pencil coding task, was used to assess complex psychomotor speed. Assessment of psychosis A structured clinical interview guide for the Hamilton depression rating scale (Williams, 1988) was used in the present study. Patients were subdivided into psychotic and nonpsychotic subtypes based on evidence of hallucination or delusions on the Hamilton rating scale at time of assessment. Classification was based on 1 or more of the following criteria, scoring 3 and above on Hamilton item 2, scoring 4 on item 15 and scoring 3 on item 20.
Order of presentation of measures The order of presentation for all subjects was as

functional domains; episodic memory, semantic memory and implicit memory, and a MANOVA was used to compare the data from each cluster. As experimental predictions were unidirectional, i.e., depression would be associated with poorer performance relative to controls, it was determined in advance that if the MANOVA was significant at the 10% level or below, this would justify inspection of the subsequent univariate comparisons. Independent t tests were carried out on individual measures of global cognitive functioning and psychomotor speed. Pearsons correlation coefficient was used to test the associations between depression severity and level of memory impairment.

3. Results The 2 groups did not differ on level of overall cognitive functioning as assessed by the mini-mental state examination, depressed mean 26.9 (3.61, control mean 28.9 (1.61, t = 1.91, P = 0.07. The data for the episodic memory tasks were grouped together for analysis (Table 1). Neither the overall MANOVA or any of the univariate comparisons achieved statistical significance. However, the RBMT profile score is an amalgam of an individuals performance on both immediate and delayed recognition and recall. A between-group analysis of the separate RBMT subscales was, therefore, carried out to determine whether the groups differed on any of the component

follows. 1. Mini-mental state 2. Verbal fluency 3. RBMT 4. Self-rating task (implicit learning) 5. Digit span 6. DSST 7. Word-stem completion (measure of implicit memory) 8. Silly sentences 9. Word-stem completion -cued recall (measure of explicit memory) 10. NART 11. BDI 12. Hamilton
Data analysis

Table 1 Performance of depressed and control subjects on episodic (overall h4ANOVA; F = 1.14, P = 0.37) Depressed RBMT DF DB EXP pas EXP neg 19.1 (5.9) 7.5 (2.4) 6.3 (2.1) 2.5 (1.4) 2.1 (1.5) Control 21.5 (1.5) 8.7 (2.2) 7.1 (2.8) 3.5 (1.7) 2.3 (1.8) F 2.28 2.09 0.96 3.21 0.05 P 0.14 0.16 0.34 0.08 0.82

tasks

All data were analysed using SPSS on the Apple Macintosh (Version 4.0). As a large number of comparisons of test scores, depressed patients vs. controls were performed, this raised the possibility of some of those comparisons achieving statistical significance by chance. To provide some protection against this, the cognitive tests were clustered into

RBMT, Rivermead behavioural memory test. DF, digits forward. DB, digits backward. EXP pos, explicit recall of positively valenced words. EXP neg, explicit recall of negatively valenced words.

6 Table 2

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Performance of depressed and control subjects on RBMT subtests (overall MANOVA; F = 2.30, P = 0.06) Depressed Recognition Pictures Faces Recall Story (immediate) Story (delayed) Route (immediate) Route (delayed) Message (immedite) Message (delayed) RBMT, Rivermead Control F P

9.5 (1.6) 4.8 (0.4) 7.lt3.6) 5.5 (3.2) 4.8 (0.6) 4.6 (0.9) 2.5 (0.6) 2.7 (0.5) behavioural

10.0 (0.0) 4.7 (0.6) 9.8 8.9 4.8 4.9 2.9 3.0 (3.5) (3.2) (0.4) (0.4) (0.3) (0.0)

1.36 0.48 4.22 8.87 0.000 1.12 5.04 5.09

0.25 0.49 0.05 0.01 1.00 0.30 0.03 0.03

memory test.

subtests (Table 2). Inspection of the univariate comparisons revealed that both immediate and delayed recall of story and message were significantly impaired in depressed subjects, however, recognition for both faces and pictures was intact. There is, therefore, some suggestion of a differential impairment, with selective deficits in immediate and delayed recall that are not present in any of the recognition tasks. There were no significant between-group differences on the 2 verbal fluency tasks or on the measures from the silly sentences task, i.e., number of errors or mean time taken to complete the task (MANOVA, F = 0.61, P = 0.66). SST number correct, depressed = 49.3 (1.21, control = 49.6 (0.5); SST reaction time, depressed = 44.3 (24.71, control = 38.5 (17.6); fluency letter M, depressed = 11.0 control = 13.0 (6.3); category fluency (5.0), (animals), depressed = 16.3 (5.5), control = 19.5 (6.4). The depressed patients were subdivided into 2 groups, psychotic or not psychotic on the basis of presence or absence of delusions and hallucinations. A MANOVA was carried out to compare depressed subjects with or without psychosis on the semantic memory measures. None of the comparisons achieved statistical significance (MANOVA, F = 0.37, P = 0.83). SST number correct, nonpsychotic (n = 7) 49.3 (1.51, psychotic (n = 8) 49.4 (0.9); SST reaction time, nonpsychotic = 47.6 (35.6), psychotic = 41.4 (10.7); verbal fluency letter M, nonpsychotic = 9.1 (4.2), psychotic = 12.6 (5.4); category fluency

(animals), nonpsychotic = 14.7 (5.6), psychotic = 17.6 (5.5). There were no significant differences between the groups in word-stem completion (priming) from either positive or negative words (MANOVA; F = 0.34, P = 0.71). Priming (positive), depressed = 0.67 (1.05), control = 0.40 (0.99); priming (negative), depressed = 0.27 (1.031, control = 0.40 (0.83). In an attempt to test the hypothesis that increasing severity of depression is associated with greater memory impairment, a correlational analysis of depressed subjects performance on long-term episodic tasks with depression severity was carried out. No statistically significant correlations were observed between severity of depression and task performance. As mentioned previously, the RBMT profile score is an amalgamation of different types of episodic tests so a further correlational analysis of the individual RBMT subtests with depression severity was carried out and, again, no statistical significant correlations were observed between the severity of depression and performance on any of the immediate and delayed recognition or recall subtests. Similarly, there was no correlation between depression severity and hedonic bias on the explicit or the implicit memory tasks. As predicted, patients suffering from major depression demonstrated significantly impaired psychomotor speed as evidenced by their DSST score: depressed mean = 37.1 (14.4), controls = 54.3 (12.3), t = 3.51, P < 0.01.

4. Discussion

The aim of the present study was to further characterize the nature of the memory deficit in major depression. The study attempted to address some of the criticisms of previous research in depression by using severely ill patients who fulfilled DSM-III-R criteria for major depression, vs. very well-matched controls. The clearest effects to emerge from the study were that depressed subjects demonstrated psychomotor slowing and evidence of a selective impairment in free recall. Depressed subjects were not impaired on a variety of other mnemonic functions, principally, short-term memory, implicit memory, recognition and semantic memory. The study also failed to find any evidence of a moodcongruent bias in either implicit or explicit memory.

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On a global measure of episodic/declarative memory (RBMT profile score), there was no significant differences between the depressed and control sample. A detailed analyses of RBMT subtests, however, revealed important group differences, depressed subjects demonstrating impairments on immediate and delayed recall of a story, and immediate and delayed memory for delivering a message. In this study, therefore, depressed subjects were intact on recognition but showed deficits in recall. Such a pattern suggests information that has been encoded but depressives show a selective impairment in the search and scanning process required for active recall of material. It is interesting to note that Danion et al. (1991), in commenting on their observation of explicit memory impairment with implicit memory preservation in depression, invoked the concept of a failure of effort demanding cognitive processes. However, this profile of memory performance is exactly that observed in the classic amnesic syndrome (Parkin and Leng, 1993). Neuropsychologists do not usually interpret a Korsakoffs patients poor performance on explicit memory tasks with preserved implicit test performance as a failure of cognitive effort, rather it is assumed that implicit memory is a dissociable function, independent of the brain structures important for declarative memory (Hamann and Squire, 1993). Perhaps the most damaging evidence against the cognitive effort model of memory impairment in depression is provided by Golinkoff and Sweeney (1989), who observed memory deficits in depressed patients independent of experimentally manipulated task difficulty. These authors concluded the poorer performance of depressed patients on memory tests reflects basic memory impairments rather than a general inability to allocate cognitive effort to more demanding tasks (p. 105). The potentially confounding effects of medication need to addressed. The majority of the patients in the present study were on stable doses of antidepressant medication. Could the recall deficits observed be simply attributable to medication rather than depression? Thompson (1991) has recently reviewed the effects of antidepressant drugs upon cognitive function and, in general, prolonged antidepressant treatment is associated with improvement in cognitive function as depressive symptoms remit. Additionally,

studies carried out on drug-free depressives have reported recall deficits in line with those observed in the present study (e.g., Austin et al., 1992). As predicted, depressed subjects failed to show any deficit in semantic memory. The results are, therefore, consistent with the general consensus of literature. However, in contrast to studies that have reported impaired performance on word fluency to category (Caine et al., 1984; Calev et al., 1989) this sample of depressed patients failed to show any such impairments. Calev et al. (1989) interpret their observation of worst performance on category fluency in terms of cognitive effort deficits in depression. The results of the depressed subjects performance on word fluency in the current study again fail to support this cognitive effort hypothesis. Similarly, in the present study, we failed to find a differential effect of semantic memory tasks as a function of psychoses. When the depressed subjects were differentiated according to evidence of psychotic features, psychotic individuals were no more impaired than nonpsychotic depressed patients on the measures of semantic memory. These preliminary results, therefore, appear to go against McKennas (1991) hypothesis that delusions consist of an inappropriate laying down of new semantic memories. However, depressive delusions tend to be integrated in comparison to the disintegrated delusions of schizophrenia (Blackburn and Davidson, 1990). It is possible that semantic memory dysfunction may prove to be more related to a disintegrated delusional symptom. As predicted, there were no differences in implicit memory between the 2 groups. The equal levels of priming observed in the 2 groups is consistent with much of the literature showing the same levels of priming in implicit tasks in chronically depressed subjects and matched controls (Bazin et al., 1994; Danion et al., 1991; Denny and Hunt, 1992; Hertel and Hardin, 1990; Watkins et al., 1992). However, in contrast to previous studies, depressed subjects were not impaired on explicit recall on the cued stem completion task. It is conceivable that the relatively short time spent by the subjects in the present study during the self-rating task, resulted in limited processing of the material to be rated, perhaps reducing any difference that may have been observed in the subsequent implicit and explicit memory task. Watkins et al. (1992) presented each word individu-

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ally for 10 s and requested their subjects to imagine themselves in a scene involved themselves and the word, thus, potentially increasing the salience of the word. It is possible that such a mode of presentation results in more elaborative processing than the presentation format used in the present study. Additionally, the limited number of words used in this study may have rendered the explicit cued recall task insensitive in detecting subtle deficits in depression. It is interesting to note that, while we observed recall deficits on the RBMT subtests, we observed no such differences between the groups on their active recall of the words used in the self-rating test. How do we account for this difference between the 2 recall tasks? One important factor is that in the RBMT, the material was explicitly learned for subsequent recall whereas in the self-rating task the learning was implicit. There was no evidence of a mood-congruent memory bias in implicit memory, as predicted. However, in contrast to that hypothesized, the current study also failed to support a mood-congruent memory bias in explicit memory. Previous studies have reported depressed subjects recalling significantly less positive than negative words in explicit tests but similar numbers of negative and positive words in implicit tests (Denny and Hunt, 1992; Watkins et al., 1992). Interestingly, Bazin et al. (1994) were also unable to demonstrate a mood-congment memory bias in explicit memory, perhaps suggesting that this is not as robust and replicable a phenomenon as is widely believed. The present study failed to find a simple correlation between mood severity and memory impairment. This result is consistent with that reported by Davis (1979) and Golinkoff and Sweeney (1989), who also found group differences in recall as a function of depression, however, depression severity was not correlated with performance. We have observed a dissociation of mnemonic functioning in major depression. Short-term, implicit, recognition and semantic memory functioning was indistinguishable from that of well-matched control subjects. However, free recall (both immediate and delayed) was selectively impaired. Depressed patients may have particular difficulty in organising the cognitive operations necessary for successful search and retrieval.

Acknowledgements

We would like to thank all the patients who participated in this study, G.M. Goodwin for his helpful criticisms and N. Brearley for expert secretarial assistance.

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