What role for cognitive remediation in the treatment of depressive symptoms? A superiority and noninferiority meta‐analysis for clinicians

Abstract

Background Cognitive remediation (CR) is a promising technique in the treatment of the cognitive dimension of depression. The present study evaluated the potential of CR in treating depressive symptoms and provides practical information about its usefulness in clinical settings. Methods We performed two meta‐analyses of published randomized (and nonrandomized) clinical trials, comparing CR to control conditions in subjects with current depressive symptomatology. The superiority meta‐analysis aimed to determine the superiority of CR when compared with placebo/waiting list interventions and its efficacy when used as an augmentation therapy. The noninferiority meta‐analysis determined whether CR had noninferior efficacy compared with standard antidepressant interventions. Results CR was found to significantly improve depressive symptomatology in the superiority meta‐analysis (CR: n = 466, control n = 478). Moreover, CR seemed to be noninferior to standard antidepressant interventions (CR: n = 230, control n = 235). CR was more effective when addressing hot (vs. cold) cognition, when involving younger patients (i.e., <30 years), and in the case of mild‐moderate (vs. severe) depression. Conclusions CR should be considered an augmentation treatment to improve treatment outcomes in depressed subjects, especially among young individuals. Interventions addressing hot cognition seem to be the most promising.

Neuropsychological Assessments of Cognitive Impairment in Major Depressive Disorder: A Systematic Review and Meta-Analysis with Meta-Regression

“…Furthermore, use of antidepressants and/or other psychotropic medications should be carefully considered since the medications themselves can have detrimental effects on cognitive performance due in part to withdrawal symptoms and/or other iatrogenic factors (e.g., extrapyramidal side effects affecting cognitive disturbances) [71]. Cognition-oriented non-pharmacological interventions (e.g., cognitive-behavioral therapy and cognitive remediation therapy) are also found to show promising results for improving cognitive impairment in MDD [69,72]. Because cognitive deficits may even persist in remission from MDD [25] or result in other neurodegenerative disorders (e.g., ADRD [11,12]), both alleviation of depressive symptoms and remediation of cognitive impairment should be prioritized when treating individuals with MDD.…”

“…These findings extend to the earlier study reported by Rock and his colleagues [ 9 ]. Because impaired cognitive functioning in MDD is associated with poor response to antidepressant treatment [ 64 , 65 ] and deteriorated psychosocial functioning [ 3 ], pharmacological and psychosocial interventions should be tailored to address cognitive impairment in these subgroup populations.…”

Improvement in self-reported cognitive functioning but not in rumination following online working memory training in a two-year follow-up study of remitted major depressive disorder

“…Thus, personalizing interventions and examine subgroups to identify those who show- and do not show benefits could be important ( 47 ). Alternatively, or in addition, rumination might show more connections to hot-cognition than cold-cognition ( 29 , 35 , 41 , 44 ), and targeting “hot cognition” could be more effective in reducing rumination and affective residual symptoms of depression ( 48 ). Thus, future studies should investigate the ability of digitally delivered interventions to target more broadly, including hot cognition and rumination, and investigate the mechanisms of cognitive training on emotion regulation ( 37 ).…”

Computerized Working Memory Training in Remission From Major Depressive Disorder: Effects on Emotional Working Memory, Processing Speed, Executive Functions, and Associations With Symptoms

“…The CWMT intervention targeted cold cognition. Targeting hot cognition instead might show larger effects on symptoms as suggested by a recent metaanalysis (Sociali et al, 2022). Future research should compare the effects on interventions targeting hot and cold cognition on several clinically relevant residual symptoms to examine utility for relapse prevention.…”