Improving Cognitive Function in Patients With MDD

In this video, Bernhard T. Baune, PhD, MD, discusses pharmacological treatments that may improve cognition in patients with major depressive disorder.

Dr. Baune, head of the Department of Mental Health at the University of Münster, Germany, presented "Advances in Understanding Neurobiological Underpinnings and Treatment Interfaces of Cognition in Depression" at the Psych Congress 2020 preconference on psychopharmacology.

Read the transcript:

Pharmacological treatments, we have common treatment with antidepressants. Here we have different classes of antidepressants, of course, so the SSRIs, the SNRIs, the tricyclics, and so forth.

I think one first principle is to use drugs which are not harmful to proper function. Some meta-analysis have shown that some of the typical or the commonly used antidepressants, I should better say, do have a negative effect on cognition. Among these are tricyclics, for example.

Therefore, it's not helpful to give someone a tricyclic when it has negative effects, although perhaps in cognition, although perhaps mood does improve in these patients. That's the first principle.

The second principle is that with many antidepressants, mood improves, as we all know. Subsequently, cognition improves, as well. It seems to go hand in hand.

There are only a few antidepressants that...Let's talk about a new antidepressant, for example, vortioxetine, which has investigated whether there is an add-on effect of cognitive improvement added on to the mood improvement and also being somewhat independent of each other.

Therefore, you could look antidepressants which have this add-on effect and independent effect on improving cognition, in addition to their mood effects.

These are, I think, the major principles when choosing an antidepressant to not just look at mood effects but also at cognitive effects and avoiding harmful effects.

Perhaps one could also look at treatments which are less common, which are more experimental.

There are some studies, again, not used in common practice, where modafinil, for example, which acts on various monoamines in the prefrontal cortex, but also other brain areas. This is a drug which has shown to increase cognitive ability.

Whether it really improves specific cognitive functions or more general ability through enhancing attention ability, for example, that is, perhaps, controversial but that is a drug which potentially could have effects on cognition in depression, as well.

Drugs used to treat dementia have not shown, so far, convincing effects to also treat cognitive dysfunction in MDD. So they should be avoided. There are some studies that actually show us some harmful effects on MDD, then, with higher relapse rates.

There are some experimental drugs like anti-inflammatory, omega-3 fatty acids. So far, they haven't been shown to have very specific effects on cognition in addition to treating depression.

In a way, the evidence is mainly focused on antidepressants, as I said before.

More from Dr. Baune: 

The Prevalence of Cognitive Dysfunction in Major Depressive Disorder

The Occurrence of Cognitive Deficits Across Psychiatric Disorders