A Systematic Review of Cognitive Predictors of Treatment Outcome in Major Depression

Abstract

Background: Research suggests that only 50% of patients with major depression respond to psychotherapy or pharmacological treatment, and relapse is common. Therefore, there is interest in elucidating factors that help predict clinical response. Cognitive impairment is a key feature of depression, which often persists beyond remission; thus, the aim of this systematic review was to determine whether baseline cognitive functioning can predict treatment outcomes in individuals with depression.Method: Studies examining cognitive predictors of treatment response in depression were identified using Pub Med and Web of Science databases. Given the heterogeneity of outcome measures, the variety of treatment protocols, and the differing ways in which data was presented and analyzed, a narrative rather than meta-analytic review technique was used.Results: 39 studies met inclusion criteria. Findings in younger adult samples were inconclusive. There was some evidence for a predictive effect of executive function and to a lesser extent, psychomotor speed, on treatment response. There was no evidence of learning or memory being associated with treatment response. In older-aged samples, the evidence was much more consistent, suggesting that poor executive function predicts poor response to SSRIs.Conclusions: Findings from the present review suggest that certain aspects of cognitive functioning, particularly executive function, may be useful in predicting treatment response in depression. This is certainly the case in elderly samples, with evidence suggesting that poor executive functioning predicts poor response to SSRIs. With further research, baseline cognitive functioning may serve as a factor which helps guide clinical decision making. Moreover, cognitive deficits may become targets for specific pharmacological or psychological treatments, with the hope of improving overall outcome.

A Hot-Cold Cognitive Model of Depression: Integrating the Neuropsychological Approach Into the Cognitive Theory Framework

“…Cold cognitive dysfunction is an area of increased clinical research focus, not only because it can be considered a biomarker for vulnerability (Allott, Fisher, Amminger, Goodall, & Hetrick, 2016), but also because it has been shown to predict poor treatment response (Groves, Douglas, & Porter, 2018), and impede functional recovery from MDD (Bortolato et al, 2016). Accumulating literature suggests that the cold cognitive dysfunction associated with MDD drives the negative consequences for everyday life and economic costs, over and above the influence of mood symptoms (Buist-Bouwman et al, 2008).…”

Predictors of Long-Term Improvement Following Cognitive Remediation in a Sample With Elevated Depressive Symptoms

“…For those experiencing cognitive difficulties, deficits often persist into remission (Rock et al, 2014) and have a deleterious effect on everyday functioning (Baune et al, 2010). Cognitive deficits, particularly in EF, are additionally associated with unfavorable depression outcomes, such as impaired long-term recovery (Vicent-Gil et al, 2018) and reduced antidepressant medication effectiveness (Groves et al, 2018). Hence, cognitive functioning represents a potential treatment target in MDD (Kaser et al, 2017).…”

A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and non-clinical populations

“…Dissociation is commonly seen in many mental health disorders and is considered a difficult symptom to treat (Lyssenko et al, 2017 ). Disconnection from emotional experiences can limit treatment outcomes or delay treatment response, as capacity for emotional processing is an important factor for treatment effectiveness (Arntz, Stupar-Rutenfrans, Bloo, van Dyck & Spinhoven, 2015 ; Groves, Douglas, & Porter, 2018 ; Jepson, Langeland, & Heir, 2014 ; Kleindienst et al, 2011 ; Prasko et al, 2016 ; Spitzer, Barrow, Freyberger, & Grabe, 2007 ; Rufer et al, 2006 ). The relationship between dissociation and treatment outcomes remains even after baseline level of pretreatment psychopathology are controlled (Kleindienst et al, 2011 ).…”