TY - JOUR
KW - antidepressant
KW - Antidepressive Agents/administration & dosage/adverse effects
KW - Cognition
KW - Cognition/drug effects
KW - Cognitive Dysfunction/diagnosis/etiology/prevention & control
KW - Depression
KW - Depressive Disorder, Major/complications/diagnosis/drug therapy
KW - Disability
KW - duloxetine
KW - Humans
KW - Neuropsychological Tests
KW - Physician's Role
KW - Physicians, Primary Care
KW - Psychiatric Status Rating Scales
KW - residual symptoms
KW - vortioxetine
AU - G. Mattingly
AU - R. H. Anderson
AU - S. G. Mattingly
AU - E. Q. Anderson
A1 - 
AB - 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.
BT - Postgraduate medicine
C5 - General Literature
CP - 7
CY - England
DO - 10.1080/00325481.2016.1221318
IS - 7
JF - Postgraduate medicine
N2 - 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.
PP - England
PY - 2016
SN - 1941-9260; 0032-5481
SP - 665
EP - 671
EP - 
T1 - The impact of cognitive challenges in major depression: the role of the primary care physician
T2 - Postgraduate medicine
TI - The impact of cognitive challenges in major depression: the role of the primary care physician
U1 - General Literature
U2 - 27500820
U3 - 10.1080/00325481.2016.1221318
VL - 128
VO - 1941-9260; 0032-5481
Y1 - 2016
ER -