Is cognitive dysfunction involved in difficult-to-treat depression? Characterizing resistance from a cognitive perspective
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Background.: This study aimed to identify clinical and cognitive factors associated with increased risk for difficult-to-treat depression (DTD) or treatment-resistant depression (TRD). Methods.: A total of 229 adult outpatients with major depression were recruited from the mental health unit at a public hospital. Participants were subdivided into resistant and nonresistant groups according to their Maudsley Staging Model score. Sociodemographic, clinical, and cognitive (objective and subjective measures) variables were compared between groups, and a logistic regression model was used to identify the factors most associated with TRD risk. Results.: TRD group patients present higher verbal memory impairment than the nonresistant group irrespective of pharmacological treatment or depressive symptom severity. Logistic regression analysis showed that low verbal memory scores (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.38–2.95) together with high depressive symptom severity (OR: 1.29; CI95%: 1.01–1.65) were associated with TRD risk. Conclusions.: Our findings align with neuroprogression models of depression, in which more severe patients, defined by greater verbal memory impairment and depressive symptoms, develop a more resistant profile as a result of increasingly detrimental neuronal changes. Moreover, our results support a more comprehensive approach in the evaluation and treatment of DTD in order to improve illness course. Longitudinal studies are warranted to confirm the predictive value of verbal memory and depression severity in the development of TRD.
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Executive function is especially impacted in TRD.
“which has important treatment implications given that it is especially impacted in TRD (López-Solà et al., 2020;Rao et al., 2019)”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as López-Solà et al., 2020
The Results report poorer executive-function performance in the TRD group than in the nonresistant group. However, they do not identify executive function as especially affected relative to other domains: verbal memory was the domain that remained significantly different after controlling for treatment and symptom severity and was associated with TRD risk (Results; Discussion, Cognitive variables). (LLM, conf=0.84)
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Cognitive Dysfunction and Suicide
Sunzeri, F. (2026) · Springer eBooks · doi:10.1007/978-3-032-14465-2_19
Oe, Y., Kurihara, M., Hayasaka, T., Nagashima, I., Murao, M., Matsumoto, Y., Takaesu, Y., Tsuboi, T., Watanabe, K., & Sakurai, H. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1838340
Ye, S., Jin, T., Wu, R., Wei, S., Chen, X., Ye, X., Zhao, H., Li, Y., Shang, D., Qi, X., et al. (2026) · Journal of Advanced Research · doi:10.1016/j.jare.2026.06.011
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Towards precision psychiatry: initial foundations and future directions
Etkin, A., O’Donnell, P., Ressler, K. J., & Manji, H. K. (2026) · Nature Reviews Drug Discovery · doi:10.1038/s41573-026-01509-0 · Cited by 1 · see citing works
- Authors
- López-Solà, C., Subirà, M., Serra-Blasco, M., Vicent-Gil, M., Navarra-Ventura, G., Aguilar, E., Acebillo, S., Palao, D. J., & Cardoner, N.
- Affiliations
- Instituto de Salud Carlos III (ES)
- Corporació Sanitària Parc Taulí (ES)
- Universitat Autònoma de Barcelona (ES)
- ORCID
- Venue
- European Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2020
- Volume
- 63
- Issue
- 1
- Pages
- e74-e74
- ISSN
- 0924-9338 (ISSN-L)
- 1778-3585
- PMC
- PMC7443785
- OpenAlex
- W3036644526
- Cited by
- 31
- References
- 66
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 2
- FWCI
- 1.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Psychiatry (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by-nc-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Instituto de Salud Carlos III (PI17/01205, PI15/01478)
- European Regional Development Fund (PI15/01478)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- treatment-resistant depression, difficult-to-treat depression, cognitive impairment, verbal memory impairment, depression severity, major depressive disorder
- MeSH terms
- Adult, Cognition, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Memory, Middle Aged, Outpatients, Odds Ratio, Cognitive Dysfunction, Depressive Disorder, Treatment-Resistant
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