Elsevier

Journal of Affective Disorders

Volume 171, 15 January 2015, Pages 85-92
Journal of Affective Disorders

Research report
Cognitive function after clinical remission in patients with melancholic and non-melancholic depression: A 6 month follow-up study

https://doi.org/10.1016/j.jad.2014.09.018Get rights and content

Abstract

Background

Cognitive symptoms are core symptoms with an impact on functioning in depression. Remission is considered as the main objective of the management and treatment of depression. This study was aimed to compare cognitive performance between melancholic (MelD) and non-melancholic depression (NMelD) and to determine whether these cognitive alterations remain after clinical remission.

Methods

We performed a 6 month follow-up study of 88 melancholic and non-melancholic depressive patients. Sociodemographic and clinical characteristics were recorded. Depression was examined using the Hamilton Depression Rating Scale and the CORE Index for Melancholia. Cognitive performance was assessed with the Trail Making Test (TMT), the Digit Span subtest of the WAIS-III, Stroop Colour Word Test (SCWT), the Tower of London (TOL DX), the Controlled Oral Word Association Test (FAS), Semantic Verbal Fluency and Finger Tapping Test (FTT).

Results

MelD patients show worse performance than N-MelD at baseline, with significant differences at Digit Span subtest of WAIS Part I and Part II, SCWT Part I and Part II, TOL DX, Total Problem Solving, Total Execution Time and FTT- Preferred hand. Cognitive impairment remains at six months follow-up after clinical remission in MelD. In the comparison between remitted and non-remitted patients, cognitive impairment in Trail Making Test Part B and Verbal and Semantic Fluency (Animals) remains after clinical remission in MelD group but not in non-melancholic patients.

Limitations

The use of psychopharmacological treatment and the small sample of melancholic patients.

Conclusions

Patients with MelD do not improve cognitive performance despite clinical remission compared with remitted NMelD patients. The persistence of some cognitive dysfunctions in MelD remitted patients could represent a trait marker of a different depressive subtype and not be secondary to disease severity.

Introduction

Cognitive symptoms are “core” symptoms of depressive disorders with clear impact on social and occupational functioning in these patients (McCall and Dunn, 2003, McIntyre et al., 2013, Jaeger et al., 2006). Cognitive impairment, including on executive functions, information processing speed, episodic and semantic memory, has been reported in different groups of patients during acute episodes of major depression (Ravnkilde et al., 2002, Porter et al., 2003).

Remission is now considered as the main objective of the management and treatment of depression. The published studies on cognitive performance on remitted patients offer controversial results: cognitive dysfunctions remain during remitted states (Neu et al., 2005, Paelecke-Habermann et al., 2005, Nakano et al., 2008, Preiss et al., 2009, Bhardwaj et al., 2010, Hasselbalch et al., 2011). Nonspecific deficits have also been found in recovered depressive patients (Reppermund et al., 2009). In a recent study of patients with at least two previous episodes, the presence of mild cognitive impairment during remission failed to predict future relapses within two years. There was no significant association between neuropsychological performance and prior course of the disease (Wekking et al., 2012).

Inconsistent findings have been also published with regard to severity of depression or depressive subtypes (Hasselbalch et al., 2011, McDermott and Ebmeier, 2009, Herrmann et al., 2007). The clinical subtypes of atypical depression, melancholic depression or psychotic depression are typically regarded as qualitatively different, or just as a more severe form of the disease (Leventhal and Rehm, 2005, Shorter, 2007, Porter et al., 2007). However, in melancholic depression, clinical episodes are characterized by lack of reactivity, psychomotor retardation, agitation, weight loss and inappropriate guilt (American Psychiatric Association, 2013). The results of one study (Marcos et al., 1994) suggested that cognitive dysfunctions in recovered melancholic patients unlikely to be state-dependent. The first and only study comparing cognitive performance of 34 patients with and without melancholic depression from hospital admission to recovery, found a distinctly different with greater cognitive impairment in the melancholic group on memory acquisition, mental flexibility, selective attention, concept-formation and multi-tasking (Withall et al., 2010). Follow-up studies comparing samples of melancholic and non melancholic depressive outpatients during an acute episode and after clinical remission are still rare and it remains unclear with current data if cognitive disturbances are state or trait factors. A key issue is to determine whether cognitive impairment predates a first episode of depression and whether cognition continues to decline as a function of disease progression.

The aim of the present study was to analyze cognitive performance between melancholic depression and non-melancholic depression and to compare cognitive dysfunction in both groups of outpatients, determining whether these alterations remain after clinical remission or not. We hypothesize a greater cognitive difficulty in the MelD group by comparison with the NMelD group analyzed.

Section snippets

Subjects, settings and procedure

A total of 88 outpatients with a DSM-IV-TR diagnosis of acute episode of major depressive disorder (MDD) were followed up after 6 months.

Consecutive patients were recruited by clinical psychiatrists from 4 health care units during the period between January 2011 and June 2011. Any outpatient who might fulfil all the inclusion criteria was invited to participate in the study. Male and female outpatients who were eligible and signed the written informed consent were entered into the study. All

Results

From a total of 88 participants, 63 patients (71.6%) receive diagnoses of non-melancholic depression (NMelD) and 25 patients (28.4%) were diagnosed as having melancholic depression (MelD).

The total sample had a mean age of 48.17 years (SD=8.95) and they were mainly women (76.1%), married (63.3%) or living accompanied (86.4%), employed (57.5%), with at least primary education studies (57.4%). 35.4% were patients in their first episode and the remaining 64.6% were recurrent depressive patients.

Discussion

The main finding of our study is that cognitive impairment remains after clinical remission in patients with melancholic depression compared with non-melancholic patients. Patients with melancholic depression present with a distinct profile of more impaired cognitive performance. At baseline both groups also shows significant differences. The NMelD patient group exhibited superior performances on tests of working memory and speed of information processing. Our results are in line with the only

Role of the funding source

The sponsor had no role in the design and development of the study, analysis, writing of the report or in the decision to submit the paper for publication. The authors declare no conflict of interest.

Conflict of interest

Dr. Roca, Ms. Monzón, Ms. Vives, Dr. García-Toro and Dr. Gili report grants from the Instituto de Salud Carlos III (Institute of Health Carlos III) of the Ministry of Economy and Competitiveness (Spain) and the European Union ERDF funds, during the conduct of the study; Dr. Roca reports personal fees from Eli Lilly, Servier and Pfizer; and grants and personal fees from Lundbeck and Jannsen, outside the submitted work. Dr. García-Campayo reports personal fees from Pfizer, Eli Lilly, Rovi and

Contributors

M Roca, S Monzón and M Gili designed the study and wrote the protocol. M Roca, C Vicens, M Vives and M Gili managed the literature searches and analyses. E López-Navarro, S Monzón and M Vives undertook the statistical analysis, and M Roca, M García-Toro, J Garcia-Campayo and J Harrison wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Acknowledgements

This project has been funded by a Grant from the Instituto de Salud Carlos III (Institute of Health Carlos III) ( FIS n° PI08 1270) of the Ministry of Economy and Competitiveness (Spain), and co-financed with European Union ERDF funds.

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