Major Depressive Disorder in recovery and neuropsychological functioning: Effects of selective serotonin reuptake inhibitor and dual inhibitor depression treatments on residual cognitive deficits in patients with Major Depressive Disorder in recovery

Herrera-Guzmán, Ixchel; Gudayol-Ferré, Esteve; Herrera-Abarca, Jorge E.; Herrera-Guzmán, Daniel; Montelongo-Pedraza, Pedro; Blázquez, Ferran Padrós; Peró‐Cebollero, Maribel; Guàrdia‐Olmos, Joan

doi:10.1016/j.jad.2009.10.009

Cited by 81 publications

(50 citation statements)

References 32 publications

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“…The authors noted that the performance at endpoint was still inferior to control group. The absence of a placebo in this underpowered study, as well as the lack of demonstration of direct effects specified a priori, leaves the results of this paper as impetus for more rigorous and refined study, and disallows conclusions about the direct effects of selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs) on cognitive function [43,44]. Refer to Table 3 for a summary of the effects of various antidepressants and psychotropic agents on measures of cognition in adults with MDD.…”

Section: Antidepressantsmentioning

confidence: 98%

The Prevalence, Measurement, and Treatment of the Cognitive Dimension/Domain in Major Depressive Disorder

et al. 2015

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Insufficient outcomes amongst adults with major depressive disorder (MDD) provide the impetus to identify and refine therapeutic targets that are most critical to outcome from patient, provider, and societal perspectives. Towards this aim, a pivotal shift towards the transnosological domain, cognition, is occurring in the study of MDD and other brain disorders. This paper aims to provide a framework for conceptualizing and prioritizing cognitive function amongst adults with MDD with a particular view to provide a conceptual framework for research and clinical priorities. We also summarize extant data pertaining to psychotropic effects, notably antidepressants, on the cognitive dimension/domain. This narrative review was based on articles identified through a PubMed/MEDLINE search of all English-language articles published between January 1966 and October 2014. The search words were major depressive disorder, depression, unipolar depression, cognition, cognitive dysfunction, cognitive deficit, and cognitive function. The search was supplemented with a manual review of relevant references. The selection of articles for inclusion in this review was based on overall methodological quality as well as on their pertinence to informing the framework described herein. Cognitive dysfunction in MDD is a discrete domain subserved by discrete yet overlapping substrates. There is a need to provide a glossary of terms commonly employed in the cognition literature for consensus as to the appropriate screening, measurement, and monitoring tools. The guiding principle of measurement-based care should include systematic assessment and measurement of cognition in subpopulations with MDD, as a tactic to improve outcome. Relatively few treatment strategies have demonstrated efficacy specifically for the cognitive domain in MDD. The antidepressant vortioxetine has replicated evidence of specific pro-cognitive effects in adults with MDD across multiple subdomains of cognitive function. Vortioxetine is a novel antidepressant that is hypothesized to act through a combination of direct effects on receptor activity and serotonin receptor inhibition, as well as other systems. Pro-cognitive effects for other US FDA-approved agents are suggested, but pseudospecificity has not been excluded as a possible explanation of their beneficial effects on cognitive function. A disparate assortment of other agents are currently under investigation for possible benefit in mitigating cognitive deficits and improving cognitive performance (e.g., intranasal insulin, erythropoietin, anti-inflammatory agents). Non-pharmacological approaches including, but not limited to, cognitive remediation (CR), aerobic exercise, and neuromodulation are promising.

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Section: Antidepressantsmentioning

confidence: 98%

The Prevalence, Measurement, and Treatment of the Cognitive Dimension/Domain in Major Depressive Disorder

et al. 2015

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“…35 In an RCT in adult patients with MDD, duloxetine was more effective than escitalopram at improving episodic and working memory at the end of 24 weeks of acute treatment 24 and 24 weeks later, when patients were unmedicated during a recovery phase. 33 There is also some support from small and uncontrolled studies that bupropion, a putative noradrenaline and dopamine reuptake inhibitor, can improve some cognitive measures in patients with depression. Treatment with bupropion for 12 weeks improved measures of visual memory and mental processing speed in 20 patients with MDD.…”

Section: Effects Of Antidepressants On Cognitive Dysfunctionmentioning

confidence: 99%

Cognitive Dysfunction in Major Depressive Disorder: Effects on Psychosocial Functioning and Implications for Treatment

et al. 2014

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Major depressive disorder is a common condition with a high rate of recurrence, chronicity, and staggering economic burden, including disability in the workforce.1 In 2010, MDD was the second leading medical cause of burden globally, with highest estimates of disability in people of working age.2 In Canada, the annual prevalence of MDD is 3% to 4% overall, and 79% of people with MDD report some interference with work functioning, either decreased work productivity and (or) absenteeism.1 In addition to work impairment, the psychosocial impact of MDD often affects a person's level of functioning in family and social relationships. While there is clearly an association between improvement in depressive symptoms and functioning, symptom improvement can also be dissociated from functional improvement and work loss.3,4 Hence there has been increasing recognition that symptomatic remission is an insufficient goal of treatment for MDD and that return to premorbid psychosocial functioning should be targeted. 5Cognitive dysfunction refers to deficits in attention, verbal and nonverbal learning, short-term and working memory, visual and auditory processing, problem solving, processing speed, and motor functioning. Cognitive dysfunction may be a primary mediator of functional impairment in MDD. 6 Cognitive complaints are core symptoms of acute MDEs, and diminished ability to think or concentrate and (or) indecisiveness are criterion items for the diagnosis of MDD. Several other core symptoms of MDD may act as mediators of cognitive dysfunction, including psychomotor retardation, amotivation, fatigue, insomnia, and mood disturbances. Deficits on neuropsychological testing are well demonstrated in people with MDD, compared with healthy subjects, with many studies and meta-analyses showing moderate effect sizes in neurocognitive domains of processing speed, attention, executive function, learning, and memory 7,8 as well as in cognitive affective bias. Cognitive affective bias reflects distorted information processing and (or) focus moving away from positive stimuli and toward negative stimuli, 7 and abnormal responses to negative feedback and decision making. It is also apparent that, while cognitive dysfunction in MDD may improve with treatment and resolution of depressive symptoms, cognitive deficits can still be detected even in periods of symptom remission. In a 3-year, follow-up study of patients with MDD, the proportion of time with cognitive complaints was reported as 94% during acute depressive episodes; this remained at 44% despite full or partial symptom remission during treatment. 10 Cognitive performance on tests of immediate memory, attention, 11 and processing speed 12 was reported to be inferior in patients with MDD who met criteria for remission, compared with healthy subjects. Meta-analyses show that cognitive deficits in executive function are still present in remitted patients, 13,14 which may explain persistent psychosocial impairment in remission.While it is beyond the scope of our paper to review the unde...

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“…Preliminary data indicate that some classes of antidepressants may be more effective for cognition [30]. A recent multicenter randomized controlled trial (RCT) demonstrated that the antidepressant vortioxetine improved subjective and objective measures of cognitive function in adults with recurrent MDD [31].…”

Section: Introductionmentioning

confidence: 99%

Cognitive Dysfunction in Depression – Pathophysiology and Novel Targets

Carvalho¹,

Miskowiak²,

Hyphantis³

et al. 2015

CNSNDDT

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Major depressive disorder (MDD) is associated with cognitive dysfunction encompassing several domains, including memory, executive function, processing speed and attention. Cognitive deficits persist in a significant proportion of patients even in remission, compromising psychosocial functioning and workforce performance. While monoaminergic antidepressants may improve cognitive performance in MDD, most antidepressants have limited clinical efficacy. The overarching aims of this review were: (1) to synthesize extant literature on putative biological pathways related to cognitive dysfunction in MDD and (2) to review novel neurotherapeutic targets for cognitive enhancement in MDD. We found that reciprocal and overlapping biological pathways may contribute to cognitive dysfunction in MDD, including an hyperactive hypothalamic-pituitary-adrenal axis, an increase in oxidative and nitrosative stress, inflammation (e.g., enhanced production of pro-inflammatory cytokines), mitochondrial dysfunction, increased apoptosis as well as a diminished neurotrophic support. Several promising neurotherapeutic targets were identified such as minocycline, statins, anti-inflammatory compounds, N-acetylcysteine, omega-3 poliunsaturated fatty acids, erythropoietin, thiazolidinediones, glucagon-like peptide-1 analogues, S-adenosyl-l-methionine (SAMe), cocoa flavonols, creatine monohydrate and lithium. Erythropoietin and SAMe had pro-cognitive effects in randomized controlled trials (RCT) involving MDD patients. Despite having preclinical and/or preliminary evidences from trials suggesting possible efficacy as novel cognitive enhancing agents for MDD, no RCT to date was performed for most of the other therapeutic targets reviewed herein. In conclusion, multiple biological pathways are involved in cognitive dysfunction in MDD. RCTs testing genuinely novel pro-cognitive compounds for MDD are warranted.

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Major Depressive Disorder in recovery and neuropsychological functioning: Effects of selective serotonin reuptake inhibitor and dual inhibitor depression treatments on residual cognitive deficits in patients with Major Depressive Disorder in recovery

Cited by 81 publications

References 32 publications

The Prevalence, Measurement, and Treatment of the Cognitive Dimension/Domain in Major Depressive Disorder

The Prevalence, Measurement, and Treatment of the Cognitive Dimension/Domain in Major Depressive Disorder

Cognitive Dysfunction in Major Depressive Disorder: Effects on Psychosocial Functioning and Implications for Treatment

Cognitive Dysfunction in Depression – Pathophysiology and Novel Targets

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