Table 3.
Evidence for Treatment of Cognitive Dysfunction With Newer-Generation Antidepressant Medications for Nonelderly Adults With Major Depressive Disordera
| Medication | Studies | Summary of Evidenceb | Description of Studies |
|---|---|---|---|
| SSRI | |||
| Paroxetine | Ferguson et al. (114), Gorlyn et al. (115), Deuschle et al. (116), Nickel et al. (117) | 0*/+/+/+ | DBRCT (N=23, 20–40 mg/day); did not separate from placebo. Three trials found improvement compared with baseline (Ns=30, 24, and 44) |
| Escitalopram | Herrera-Guzmán et al. (118, 119), Soczynska et al. (120) | +/+ | Improvements in objective cognition compared with baseline performance and untreated controls (Ns=36 and 19). |
| Sertraline | Constant et al. (121) | + | Improvements in attention, executive function, and psychomotor speed (N=20) |
| Fluoxetine | Chang et al. (122), Richardson et al. (123), Levkovitz et al. (124) | +/+/+ | Three trials showing improvement in objective cognition compared with baseline (Ns=73, 18, and 8) |
| SNRI | |||
| Duloxetine | Herrera-Guzmán et al. (118, 119), Mahableshwarkar et al. (125) | 0*/+ | Improved memory, attention, and executive function compared with baseline in one sample (N=37). DBRCT (N=176, 60 mg/day) showed improved subjective cognition but no difference in processing speed and functional capacity compared with placebo. |
| Venlafaxine | Chang et al. (122) | + | Improved attention and executive function compared with baseline (N=72) |
| SSRI/SNRI | Nagane et al. (126) | − | Remitted patients receiving unspecified SSRI or SNRI antidepressants showed decreased visual memory compared with nonmedicated controls (N=21) |
| NDRI: buproprion | Gorlyn et al. (115), Soczynska et al. (120), Herrera-Guzmán et al. (127) | +/+/+ | Improved verbal and nonverbal memory compared with baseline in two studies (Ns=17 and 27) and improved visual memory and processing speed (N=20) |
| NaSSA: mirtazapine | Borkowska et al. (128) | + | Improvements in working memory, processing speed, and executive function after six months of treatment compared with baseline (N=71) |
| NRI: reboxetine | Ferguson et al. (114) | +* | DBRCT (N=25, 8–10 mg/day) demonstrated improved attention and processing speed compared with placebo |
| Multimodal vortioxetine | Mahableshwarkar et al. (125), McIntyre et al. (129) | +*/+* | DBRCT (N=168, 10–20 mg/day) showed improved processing speed and functional capacity compared with placebo; DBRCT of 10 mg/day (N=195) and 20 mg/day (N=207) found improvements in subjective and objective cognition compared with placebo at both doses |
a
SSRI, selective serotonin reuptake inhibitor; EF, executive function; SNRI, selective norepinephrine reuptake inhibitor; NDRI, norepinephrine and dopamine reuptake inhibitor; NaSSA, noradrenergic and specific serotonergic antidepressant; NRI, norepinephrine reuptake inhibitor.
b
+, positive trial; 0, trial with no statistically significant results; −, negative trial. Asterisk indicates placebo-controlled, double-blinded randomized controlled trials (DBRCT).