The impact of cognitive challenges in major depression: the role of the primary care physician
Abstract
Nearly 1 in 5 Americans will struggle with major depression in their lives; some will have recurring bouts. Recent psychiatric research has given new attention to the prevalence of cognitive deficits in major depression and the impact such deficits have on remission and overall life functioning. When depression is partially treated i.e., leaving residual symptoms, patients have higher rates of relapse and lower functional outcomes. Impaired cognitive functioning is a frequent residual symptom, persisting in about 45% of patients even when emotional symptoms have improved, and results in a disproportionate share of the functional impairment, particularly in the workplace. Patients with depression have disrupted circuitry in brain regions responsible for cognition and it is therefore important to screen depressed patients for cognitive as well as emotional symptoms. Cognitive dysfunction should be evaluated in every mood disordered patient with validated self-report scales such as the Patient Health Questionnaire-9 or the Beck Depression Inventory and objective measures of cognitive function are also very very useful. Two easily administered tests are the Trails B Test and the Digit Symbol Substitution Test. Each take less than two minutes and measure working memory, executive function, and processing speed and can track cognitive improvement in depressed patients. Treatment of cognitive dysfunction in major depression is complicated by the 'serotonin conundrum': SSRI's frequently do not treat to full remission, and can cause cognitive blunting-actually adding to cognitive problems. Based on recent data including results from a recently completed meta-analysis by McIntyre and colleagues, an evidence-based algorithm for treating cognitive symptoms in depression is presented. A hierarchy of antidepressants and augmentation strategies based on the best available evidence is discussed. In conclusion, cognitive symptoms in major depressive disorder have been recognized as a target of therapeutic improvement by the FDA and have become a focus of clinical importance.
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There is growing awareness of the prevalence of cognitive symptoms and their impact on life functioning in MDD patients, leading to increased recognition of such symptoms as clinically important targets for therapeutic improvement.
“Further, there is growing awareness of the prevalence of cognitive symptoms and their impact on life functioning in MDD patients, leading to an increase in the recognition of such symptoms as clinically important targets for therapeutic improvement.47”
From Digit Symbol Substitution Test: The Case for Sensitivity Over Specificity in Neuropsychological Testing (2018) · cites this paper as [47]
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- Authors
- Mattingly, G., Anderson, R. H., Mattingly, S. G., & Anderson, E. Q.
- Affiliations
- Department of Psychiatry, Washington University School of Medicine, Saint Charles, MO, USA
- Political Research Associates (US)
- Corresponding author
- Mattingly, Gregory
- Venue
- Postgraduate Medicine
- Publisher
- Informa UK Limited
- Published
- 2016-08-16
- Volume
- 128
- Issue
- 7
- Pages
- 665-671
- ISSN
- 0032-5481 (ISSN-L)
- 1941-9260
- OpenAlex
- W2506704002
- Semantic Scholar
- c56a2a25afb493f3226383a4562c505ff069bb2a
- Cited by
- 24
- References
- 47
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 2 · 2021: 2 · 2019: 2 · 2018: 3 · 2017: 2
- FWCI
- 0.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Postgraduate Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- major depressive disorder, cognitive impairment, primary care physician role, cognitive screening, working memory, executive function, processing speed, Digit Symbol Substitution Test, antidepressant augmentation, treatment algorithm, relapse, functional disability
- MeSH terms
- Antidepressive Agents, Cognition, Major Depressive Disorder, Humans, Neuropsychological Tests, Physician's Role, Psychiatric Status Rating Scales, Physicians, Primary Care, Cognitive Dysfunction
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