Procognitive Effects of Antidepressants and Other Therapeutic Agents in Major Depressive Disorder: A Systematic Review

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Abstract

Objective: To review the efficacy of antidepressants and other therapeutic agents for the treatment of cognitive impairment in adults with major depressive disorder (MDD).

Data Sources: We conducted a database search of MEDLINE, PsycINFO, and Embase through Ovid on May 7, 2019. The year of publication was not restricted. The search terms “Major Depressive Disorder,” “depress*,” “cognit*,” and “therapeutics” were used.

Study Selection: The studies included in this review were clinical trials of antidepressants and other therapeutic agents in MDD populations. Participants were aged between 18 and 65 years and had a DSM-III, -IV, or -5 diagnosis of MDD. In total, 2,045 research papers were screened, 53 full-text articles were assessed, and 26 articles were eligible to be included in this systematic review.

Data Extraction: The data and quality of research papers were assessed and screened by 2 independent reviewers. Discrepancies were resolved through a third reviewer.

Results: Overall, studies demonstrated that tricyclic antidepressants do not have procognitive effects, while vortioxetine and bupropion have demonstrated procognitive effects in MDD populations relative to selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Several non-antidepressant agents, such as modafinil, amphetamines, and erythropoietin, have also demonstrated significant positive effects on cognition in depression.

Conclusions: Present-day antidepressants and other agents have demonstrated procognitive effects in MDD, but the findings between various agents are mixed. Further research looking at objective measures of cognitive performance would be helpful to obtain more definitive results regarding the efficacy of therapeutics for cognitive impairment in MDD.

To cite: Blumberg MJ, Vaccarino SR, McInerney SJ. Procognitive effects of antidepressants and other therapeutic agents in major depressive disorder: a systematic review. J Clin Psychiatry. 2020;81(4):19r13200.

To share: https://doi.org/10.4088/JCP.19r13200


Read the whole article at psychiatrist.com here:
Procognitive Effects of Antidepressants and Other Therapeutic Agents in Major Depressive Disorder: A Systematic Review

© Copyright 2020 Physicians Postgraduate Press, Inc.

Target Audience

Psychiatrists

Learning Objectives

Try to address cognitive impairments in patients with major depressive disorder using the latest data to guide prescribing

Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
07/21/2020
Activity expires: 
08/31/2022
Cost:
$10.00
Rating: 
0

CME Background

Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results. To obtain credit, read the article, correctly answer the questions in the Posttest, and complete the Evaluation. A $10 processing fee will apply.

CME Objective

After studying this article, you should be able to:

  • Try to address cognitive impairments in patients with major depressive disorder using the latest data to guide prescribing

Statement of Need and Purpose

Cognitive impairment is estimated to affect two-thirds of individuals with MDD and is associated with psychosocial impairment. A prior review indicated that antidepressants have a significant positive effect on psychomotor speed and delayed recall in adults with MDD, although no significant difference between classes was found. However, certain antidepressants were excluded, and it did not investigate the relationship between cognition and functional outcomes. Further, new clinical trials have been conducted. Therefore, clinicians need education on a more complete, up-to-date review of medications.

Release, Expiration, and Review Dates

This educational activity was published in July 2020 and is eligible for AMA PRA Category 1 Credit™ through August 31, 2022. The latest review of this material was July 2020.

Disclosure of Off-Label Usage

The authors have determined that, to the best of their knowledge, imipramine, amitriptyline, clovoxamine, escitalopram, vortioxetine, duloxetine, paroxetine, fluoxetine, fluvoxamine, desvenlafaxine, levomilnacipran, reboxetine, citalopram, bupropion, lisdexamfetamine, modafinil, erythropoietin, and intranasal insulin are not approved by the US Food and Drug Administration for the treatment of cognitive impairment in major depressive disorder.

Funding/Support

None.

Faculty Affiliation


Michelle J. Blumberg, BScH
Centre for Depression and Suicide Studies, St Michael’s Hospital, Toronto, Ontario, Canada

 


Sophie R. Vaccarino, BScH*
Centre for Depression and Suicide Studies, St Michael’s Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
 


Shane J. McInerney, MD, MB, MSc, MRCPsych
Centre for Depression and Suicide Studies, St Michael’s Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; University Hospital Galway, Galway, Ireland


*Corresponding author: Sophie R. Vaccarino, BScH, Research Assistant, ASR Suicide & Depression Studies Program, St Michael’s Hospital, 193 Yonge St, 6th Fl, Toronto, ON M5B 1M4, Canada (sophia.vaccarino@unityhealth.to).

Financial Disclosure

All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief of The Journal of Clinical Psychiatry, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; has been a member of the Steering Committee for Educational Activities for Medscape; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships.

Dr McInerney has received consulting fees from Janssen in the last 5 years. Mss Blumberg and Vaccarino have no personal affiliations or financial relationships with any commercial interest to disclose relative to the article.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Price

Cost:
$10.00
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