The depression‐executive dysfunction (DED) syndrome and response to antidepressants: a meta‐analytic review
Abstract
Background: The depression‐executive dysfunction (DED) model predicts that cognitive impairment, particularly executive dysfunction, is associated with poor response to antidepressant medication. A meta‐analysis was undertaken to assess the evidence for this hypothesis. Methods: The PsycInfo and PubMed databases were searched to identify studies that examined response to antidepressant treatment in relation to pre‐treatment cognitive performance. Systematic screening yielded 17 eligible publications, providing data for 1269 individuals. Ninety cognitive tests and subtests were used by these studies; 30 were used by more than one study. Weighted mean Cohen's d effect sizes, 95% confidence intervals and Fail Safe Ns were calculated for these 30 tests. Results: Five cognitive tests provided good discrimination ( d w > 0.5) between patients who ultimately responded to antidepressant medication and those who failed to respond. One was a test of executive function but the remainder assessed other cognitive domains. Due to the small number of studies the influence of methodological factors, such as participant age and treatment duration, could not be statistically examined. However, a supplementary analysis restricted to nine studies where SSRIs were the only class of antidepressant revealed a similar pattern of results. Conclusions: Performance on selected tests of executive function and non‐executive cognitive functions is associated with response to anti‐depressant medication in some populations. The available evidence does not provide strong support for the DED model. Copyright © 2010 John Wiley & Sons, Ltd.
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Pre-treatment EF predicts pharmacotherapy response in individuals with depression, schizophrenia, OCD, and BD.
“In particular, EF predicts pharmacotherapy response in individuals with depression (e.g., McLennan and Mathias, 2010), schizophrenia (e.g., Kim et al., 2008), OCD (e.g., D’Alcante et al., 2012), and BD (e.g., Gruber et al., 2008).”
From Advancing understanding of executive function impairments and psychopathology: bridging the gap between clinical and cognitive approaches (2015) · cites this paper as McLennan and Mathias, 2010
A meta-analysis of 17 studies of late-life major depressive disorder indicated that better performance on tests of executive function and non-executive function is associated with response to antidepressant treatment.
“However, a meta-analysis of 17 studies of late-life MDD indicated that better performance on tests of executive function (i.e. Dementia Rating Scale initiation and perseveration subtest) and non-executive function (including two tests of psychomotor speed, one test of construction, and one test of memory) is associated with response to antidepressant treatment [79].”
From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [79]
Specific cognitive deficits per se do not offer a reliable basis for making clinical judgments about probable illness course.
“Thus, the authors concluded that specific cognitive deficits per se do not offer a reliable basis for making clinical judgments about probable illness course, in contrast to the depression-executive dysfunction model, according to which the occurrence of executive dysfunction portends poor response to antidepressant medication.”
From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [79]
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- Authors
- McLennan, S. N., & Mathias, J. L.
- Affiliations
- The University of Adelaide (AU)
- Corresponding author
- Mathias, Jane L.
- Venue
- International Journal of Geriatric Psychiatry
- Publisher
- Wiley
- Published
- 2010-05-07
- Volume
- 25
- Issue
- 10
- Pages
- 933-944
- ISSN
- 0885-6230 (ISSN-L)
- 1099-1166
- OpenAlex
- W2109315694
- Cited by
- 95
- References
- 54
- Citations by year
- 2025: 2 · 2024: 6 · 2023: 4 · 2022: 10 · 2021: 6 · 2020: 4 · 2019: 2 · 2018: 7 · 2017: 7 · 2016: 7 · 2015: 14 · 2014: 5 · 2013: 12 · 2012: 5
- FWCI
- 0.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- executive dysfunction, cognitive impairment, antidepressant response, treatment-resistant depression, selective serotonin reuptake inhibitors, cognitive domain
- MeSH terms
- Antidepressive Agents, Cognition, Cognition Disorders, Depressive Disorder, Female, Humans, Male, Models, Biological, Executive Function
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