Trisha Chakrabarty1, Shane J McInerney2, Ivan J Torres3,4, Benicio N Frey5,6, Roumen V Milev7,8, Daniel J Müller2, Susan Rotzinger2, Sidney H Kennedy2, Raymond W Lam3. 1. Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada. trisha.chakrabarty@ubc.ca. 2. Department of Psychiatry, University of Toronto, Toronto, ON, Canada. 3. Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada. 4. British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada. 5. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada. 6. Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. 7. Department of Psychology, Queen's University, Kingston, ON, Canada. 8. Department of Psychiatry, Queen's University, Kingston, ON, Canada.
Abstract
BACKGROUND: Cognitive deficits are detectable in major depressive disorder (MDD). The cognitive impact of antidepressants remains unclear, as does the cognitive effects of aripiprazole in MDD, a commonly used adjunct with putative pro-cognitive properties. OBJECTIVES: In this multi-centre, open-label study, cognitive changes associated with escitalopram monotherapy and adjunctive aripiprazole were examined. METHODS: Acutely depressed participants with MDD (n = 209) received 8 weeks of escitalopram. Non-responders received an additional 8 weeks of adjunctive aripiprazole (ESC-ARI, n = 88), while responders (ESC-CONT, n = 82) continued escitalopram monotherapy (n = 39 lost to attrition). ESC-ARI, ESC-CONT and matched healthy participants (n = 112) completed the Central Nervous System Vital Signs cognitive battery at baseline, 8 and 16 weeks. Linear mixed models compared participants with MDD cognitive trajectories with healthy participants. RESULTS: Participants with MDD displayed poorer baseline global cognition (assessed via the Neurocognitive Index), composite memory and psychomotor speed vs healthy participants. There were no statistically significant changes in participants with MDD receiving escitalopram monotherapy from baseline to week 8 in the neurocognitive index, reaction time, complex attention, cognitive flexibility, memory or psychomotor speed. Overall symptom severity changes were not associated with cognitive changes. The ESC-CONT group displayed no significant cognitive changes from weeks 8 to 16; reaction time worsened in the ESC-ARI group (p = 0.008) from weeks 8 to 16, independent of symptom change. CONCLUSIONS: Escitalopram monotherapy in acute MDD did not result in significant cognitive improvements. We provide novel evidence that escitalopram continuation in responders does not adversely affect cognition, but adjunctive aripiprazole in escitalopram non-responders worsens reaction time. Treatments targeting cognitive dysfunction are needed in MDD. CLINICALTRIALS. GOV IDENTIFIER: NCT01655706; 2 August, 2012.
BACKGROUND: Cognitive deficits are detectable in major depressive disorder (MDD). The cognitive impact of antidepressants remains unclear, as does the cognitive effects of aripiprazole in MDD, a commonly used adjunct with putative pro-cognitive properties. OBJECTIVES: In this multi-centre, open-label study, cognitive changes associated with escitalopram monotherapy and adjunctive aripiprazole were examined. METHODS: Acutely depressed participants with MDD (n = 209) received 8 weeks of escitalopram. Non-responders received an additional 8 weeks of adjunctive aripiprazole (ESC-ARI, n = 88), while responders (ESC-CONT, n = 82) continued escitalopram monotherapy (n = 39 lost to attrition). ESC-ARI, ESC-CONT and matched healthy participants (n = 112) completed the Central Nervous System Vital Signs cognitive battery at baseline, 8 and 16 weeks. Linear mixed models compared participants with MDD cognitive trajectories with healthy participants. RESULTS: Participants with MDD displayed poorer baseline global cognition (assessed via the Neurocognitive Index), composite memory and psychomotor speed vs healthy participants. There were no statistically significant changes in participants with MDD receiving escitalopram monotherapy from baseline to week 8 in the neurocognitive index, reaction time, complex attention, cognitive flexibility, memory or psychomotor speed. Overall symptom severity changes were not associated with cognitive changes. The ESC-CONT group displayed no significant cognitive changes from weeks 8 to 16; reaction time worsened in the ESC-ARI group (p = 0.008) from weeks 8 to 16, independent of symptom change. CONCLUSIONS: Escitalopram monotherapy in acute MDD did not result in significant cognitive improvements. We provide novel evidence that escitalopram continuation in responders does not adversely affect cognition, but adjunctive aripiprazole in escitalopram non-responders worsens reaction time. Treatments targeting cognitive dysfunction are needed in MDD. CLINICALTRIALS. GOV IDENTIFIER: NCT01655706; 2 August, 2012.
Authors: Richard S E Keefe; Shawn M McClintock; Robert M Roth; P Murali Doraiswamy; Steven Tiger; Manisha Madhoo Journal: J Clin Psychiatry Date: 2014-08 Impact factor: 4.384
Authors: Beatrice Bortolato; Kamilla W Miskowiak; Cristiano A Köhler; Michael Maes; Brisa S Fernandes; Michael Berk; André F Carvalho Journal: BMC Med Date: 2016-01-22 Impact factor: 8.775