Enabling Discovery, Development, and Translation of Treatments for Cognitive Dysfunction in Depression Workshop Summary (2015) / Chapter Skim
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3 State of the Science: Treatment Development
3 State of the Science: Treatment Development
Pages 15-24
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From page 15... ...
. • Pharmacological treatment of depression has only small beneficial effects on certain aspects of cognition, such as verbal and visual memory, and may even worsen others such as processing speed (Keefe)
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From page 16... ...
These challenges relate to selection of the appropriate study design, patient population, and assessment tools, as well as the method of data analysis. Keefe discussed a meta-analysis of the literature that he and his colleagues conducted to assess the effects of antidepressant monotherapy and augmentation therapy (i.e., adding a second drug to existing antidepressant therapy)
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From page 17... ...
Most studies also assessed cognitive function in the presence of mild to severe depressive symptoms, which made it difficult to determine whether treatment directly affected cognition or if effects were secondary to changes in mood. Furthermore, the studies used a wide variety of tests across multiple domains, including processing speed, psychomotor function, attention, verbal learning and memory, verbal fluency, visuospatial awareness, and executive function.
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From page 18... ...
Although tentative trends toward cognitive improvements from both monotherapy and augmentation therapy emerged, the studies were limited by a high degree of variability in study design, numbers of patients enrolled, duration of treatment, outcome measures, and heterogeneity among patients (e.g., comorbidities and the severity of depression)
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From page 19... ...
NON-INVASIVE NEUROMODULATION Based on findings discussed earlier about the neurobiological basis of cognitive dysfunction in depression, a variety of nonpharmacologic treatments are being considered as potential treatments, including transcranial magnetic stimulation (TMS) , especially repetitive TMS (rTMS)
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From page 20... ...
. A new type of treatment called metacognitive therapy, which targets perseverative thinking and includes an attentional training component, has shown some promise in improving spatial working memory and executive functioning in patients with depression.
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From page 21... ...
. Eaarly studies of o cognitive remediation r in depressionn have, for tthe most part, p failed to address a all three pillars, but have involvedd computerizzed cognitive training in i small, min nimally contrrolled studiess.
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From page 22... ...
These results prompted the researchers to explore how to focus cognitive remediation approaches on acquisition of everyday skills and behaviors and how to help people understand how to use new-found abilities in everyday life. In response to the lack of improvements in self-rated behavior seen in these studies, Bowie and colleagues developed an "Action-Based Cognitive Remediation Program," which takes a holistic behavioral therapy approach.
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From page 23... ...
Etkin concurred, adding that while many participants supported the idea of subtyping, it points to the need for many more targets and tools to match subgroups to mechanisms to interventions. Patricia Areán, then professor of psychiatry at the University of California, San Francisco, School of Medicine, suggested that cognitive responses to treatment may help identify subgroups of depression as well as appropriate therapeutic approaches.
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