Cognitive Symptoms of Depression and Their Implications for Clinical Practice

Cognitive Symptoms of Depression and Their Implications for Clinical Practice

Research suggests depression affects much more than our mood—it affects our cognitive abilities. What does this mean, and what are these cognitive symptoms of depression?

This post will define and discuss the cognitive symptoms of depression, while also providing a potential new treatment option for you to discuss with your doctor. Continue reading to learn more about how your brain works during a depressive episode, and how research into the cognitive symptoms of depression has changed the way we treat depression. 

What Are the Cognitive Symptoms of Depression?

In a 2014 article entitled “Cognitive Symptoms in Patients With Major Depressive Disorder and Their Implications for Clinical Practice,” Dr. George Papakostas’s lists the core cognitive symptoms of depression:

  • A diminished ability to think
  • Impaired concentration
  • Difficulty in making decisions

More specifically, sufferers of major depressive disorder (MDD) can experience diminished memory, attention, executive functioning, and psychomotor speed. MDD is surprisingly common and patients often suffer frequent relapses and interruptions to their day due to incomplete recoveries before their next depressive episode occurs. According to a 2015 study, approximately 30% of patients with MDD don’t respond to treatment and have decreased cognitive functioning. 

But what does all this mean? Let’s start with the term ‘cognitive.’ The Merriam-Webster definition is as follows:

of, relating to, being, or involving conscious intellectual activity (such as thinking, reasoning, or remembering)”of

Healthy cognitive function is important to our daily lives. It affects how we work, interact with our friends and family, and make decisions throughout the day. It also affects our ability to perform physical tasks.

How Do the Cognitive Symptoms of Depression Manifest Themselves?

There are many different symptoms of depression which extend far beyond an overarching feeling of sadness. For example, there are physical symptoms (such as fatigue, muscle aches, weight fluctuations, and headaches) of depression as well as symptoms that manifest themselves in a person’s emotions. 

In addition, there are cognitive symptoms of depression that affect the way we complete mental tasks, remember things, focus, and make plans or make other decisions. Moreover, the cognitive symptoms of depression can manifest themselves in decreased reaction time, trouble communicating fluently, and reduced motor function. Cognitive symptoms of depression are associated with early illness onset and can last for the duration of the illness.

Cognitive difficulties increase with both the number of major depressive episodes (MDEs) and duration of those MDEs.

Findings such as these can be alarming, and they illustrate just how much of an impact depression can have on our daily lives.

How Do the Cognitive Symptoms of Depression Influence Clinical Practice?

The cognitive symptoms of depression are among the most distressing and impactful ones for depression sufferers, and they can inhibit a patient’s success with various treatments for depression.

Experts have been measuring the success of a wide variety of antidepressant drugs, each of which having their own degrees of success.  The cognitive symptoms of depression improve at a slow rate during treatment, and that they can persist into remission and resurface throughout posttreatment. Moreover, because common antidepressants work to bolster patients’ moods, cognition usually exhibits a synchronous improvement meaning it can be difficult to discern whether antidepressants offer added-on or independent effects on cognition.

To combat this, new research is being conducted and mental health professionals are keeping their practices up-to-date with the latest treatments and methods, for relief from the cognitive symptoms of depression. 

Among these practices is the use of the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ). The CPFQ is a 7-part questionnaire that’s designed to measure a patient’s memory and concentration capabilities.  The CPFQ allows the practitioner to measure a patient’s positive progress with the cognitive symptoms of depression and adjust your treatment accordingly to get you the best results.

Findings have shown that antidepressants can improve the cognitive symptoms of depression. However, the results tend to vary widely between drugs and are unpredictable. Also, certain kinds of depression like treatment resistant depression (TRD) are not responsive to pharmaceuticals. Although the majority of depression treatments revolve around pharmacological remedies, there are promising findings in nonpharmacological treatments, such as transcranial magnetic stimulation (TMS), for the cognitive symptoms of depression.

Can TMS Help the Cognitive Symptoms of Depression?

Research has shown that repetitive transcranial magnetic stimulation (rTMS) may be considered an effective technique to improve cognitive function for patients with TRD. 

TMS is a non-invasive depression treatment that uses magnetic pulses to target the low-activity areas of the brain. TMS can either be used in conjunction with antidepressant medication or on its own. TMS specifically targets the dorsolateral prefrontal cortex, an area believed to be underactive in depression sufferers.

The dorsolateral prefrontal cortex (DLPFC) is a crucial region of the brain where the cognitive symptoms of depression stem from. The dorsolateral prefrontal cortex is also partially responsible for executive functioning, a major subset of cognitive skills that depression can affect. Studies have shown that stimulation of the DLPFC has led to increased neurocognition, specifically in verbal memory. Although this application of TMS requires further research, there is a direct and positive relationship between TMS and executive functioning.

Research has shown that rTMS does not decrease cognitive performance. There was a modest but substantial development in cognitive function when studies were conducted. Researchers stimulated the left DLPFC using high frequency rTMS over a short amount of time and a long amount of time. These improvements were related to memory and fine motor skills. A study on the effectiveness of rTMS treatment reflected that 42.9% of depressive resistant patients were responsive to treatment. 

Unlike other depression treatments, which may take longer to provide results, high frequency rTMS studies have shown improvements in 53% of patients after 2 weeks. Though rTMS does not provide immediate results to the cognitive symptoms of depression, it is still a viable treatment option. 

Mid City TMS Can Help With the Cognitive Symptoms of Depression

While the cognitive symptoms of depression can be debilitating, the medical community is making positive strides towards finding treatments that bring depression patients relief. The Food and Drug Administration has approved rTMS to be a treatment for MDD and TRD. Treatment has been approved for adolescents and adults.

Dealing with the cognitive symptoms of depression every day can be exhausting and make you feel hopeless. If you’re interested in exploring your depression treatment options, and finally getting some reprieve from your cognitive depression symptoms, don’t hesitate to reach out to us here at Mid City TMS.

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