RESUMO
Several reports suggest that antidepressants may improve cognitive functioning in patients with major depressive disorder (MDD). The present work aims to study the effects of selective serotonin reuptake inhibitors (SSRIs) and serotonergic-noradrenergic reuptake inhibitors (SNRIs) treatments on the performance of working memory, attention and executive functions in patients with MDD. A total of 73 subjects meeting the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV) criteria for MDD, and 37 control subjects were assessed with the Hamilton Depression Rating Scale and a neuropsychological battery. The subjects were medicated with escitalopram (n=36) or duloxetine (n=37) for 24 weeks. At the end of the trial, the subjects were assessed again with the same tests. The depressed subjects showed alterations in attention and cognitive functions when compared to the control group. The administration of both treatments improved working memory, as well as attention and all the executive functions, but the cognitive functions of depressed patients do not improve enough to reach the levels of performance of the control subjects. Our results suggest that both SSRI and SNRI treatments presented the same efficacy in improving attention and the remaining executive functions.
Assuntos
Inibidores da Captação Adrenérgica/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Citalopram/uso terapêutico , Transtornos Cognitivos/tratamento farmacológico , Função Executiva/efeitos dos fármacos , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Tiofenos/uso terapêutico , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtornos Cognitivos/etiologia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Cloridrato de Duloxetina , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Psicometria , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Cognitive disturbances in Major Depressive Disorder (MDD) could persist beyond the symptomatic phase of the illness. However, the works addressing this topic did not usually account for the possible impact of medication on the cognitive functions of depressed patients. The present study aims to investigate whether MDD patients in remission treated with selective serotonin reuptake inhibitors (SSRI) or dual serotonergic-noradrenergic reuptake inhibitors (SNRI) show cognitive deficits, to study whether the same patients suffer neuropsychological disturbances when they are unmedicated and in recovery phase, and if the previous pharmacological treatment used to achieve the remission of MDD clinical symptoms had any effect in the profile of these patients' cognitive performance in the recovery phase. METHODS: Thirty-six subjects with MDD treated with escitalopram and 37 depressed patients with duloxetine were compared both in remission phase and 24 weeks later, when they were unmedicated and in recovery phase. They were also compared, in both moments, to 37 healthy subjects. RESULTS: The control subjects showed a broader better cognitive performance than MDD patients in both measurement moments, but several cognitive functions improved over time. Also, the patients treated with SNRI performed better in memory tests than the SNRI-treated patients in remission phase, and in recovery phase. LIMITATIONS: Our sample size is somewhat small, and we followed our patients only for 6months after treatment. CONCLUSIONS: Cognitive functions improve over time in patients with MDD beyond the remission phase, and the antidepressant treatment class used in acute depressive phase could influence his/her memory improvement.
Assuntos
Antidepressivos/uso terapêutico , Citalopram/uso terapêutico , Transtornos Cognitivos/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Inventário de Personalidade , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Tiofenos/uso terapêutico , Escalas de Wechsler , Adulto , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/genética , Ensaios Clínicos Controlados como Assunto , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/genética , Cloridrato de Duloxetina , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valores de ReferênciaRESUMO
Patients with major depressive disorder (MDD) usually suffer from altered cognitive functions of episodic memory, working memory, mental processing speed and motor response. Diverse studies suggest that different antidepressant agents may improve cognitive functions in patients with MDD. The aim of this work is to study the effects of serotonergic reuptake inhibitors (SSRIs) and serotonergic-noradrenergic reuptake inhibitors (SNRIs) treatments to improve the performance on memory tasks and mental processing speed in MDD. Seventy-three subjects meeting criteria for major depressive disorder were assessed with the Hamilton depression rating scale and a neuropsychological battery. The subjects were medicated with escitalopram (n=36) or duloxetine (n=37) for 24 weeks. At the end of the trial, the subjects were assessed again with the same neuropsychological battery used prior to the treatment. Both treatments improved importantly the episodic memory and to a lesser extent, working memory, mental processing speed and motor performance. Our results suggest that cognition is partially independent from improvement in clinical symptoms. Both groups achieved remission rates in the HAM-D-17 after 24 weeks of treatment, but SNRI was superior to SSRI at improving episodic and working memory. Our work indicates that the superiority of SNRI over the SSRI at episodic memory improvement is clinically relevant.
Assuntos
Antidepressivos/uso terapêutico , Cognição/efeitos dos fármacos , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Memória/efeitos dos fármacos , Desempenho Psicomotor/efeitos dos fármacos , Tempo de Reação/efeitos dos fármacos , Adulto , Análise de Variância , Citalopram/uso terapêutico , Transtorno Depressivo Maior/diagnóstico , Cloridrato de Duloxetina , Humanos , Masculino , Testes Neuropsicológicos , Inibidores da Captação de Neurotransmissores/uso terapêutico , Escalas de Graduação Psiquiátrica , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Índice de Gravidade de Doença , Pensamento/efeitos dos fármacos , Tiofenos/uso terapêuticoRESUMO
Cognitive effects of antidepressants and cognitive predictors of antidepressant treatment response are recent focuses of interest in the neuropsychology of depression. We studied the cognitive predictors of treatment response to bupropion and its neuropsychological effects in patients with major depressive disorder. Twenty subjects meeting the DSM-IV criteria for major depressive disorder were assessed with the Hamilton Depression Rating Scale and a neuropsychological battery. Subjects were medicated with 150 mg/day of bupropion sustained release for 8 weeks. At the end of the trial, 12 subjects were classified as responders to treatment and 8 were non-responders. Our findings suggest that low pretreatment measures of visual memory and low levels of mental processing speed are predictive of good response to bupropion. The cognitive effects of bupropion after the treatment showed that patients improved in visual memory measures and in mental processing speed. Our results suggest that cognitive predictors of treatment response to bupropion and cognitive effects of bupropion in patients with major depressive disorder could be closely related. These findings need to be replicated due to the exploratory nature of the present work.