Professor Marcos Gebara is a semi-retired, former hospital-based psychiatrist working in Rio de Janeiro, Brazil. Typically he sees approximately 15 patients with major depressive depression each week. Here we asked his opinions about cognition in depression.
Why is it so difficult for depressed patients to achieve sustained remission in real-life?
To be honest, residual symptoms remain even when patients achieve remission and it’s these - cognitive dysfunction, somatic symptoms, behavioral symptoms – that make treatment difficult and underlie further relapses.
These residual symptoms are easily perceived. Patients complain about them, and even when they don’t, they can be easily identified in follow-up interviews.
Now we talk about total, functional recovery. In the past, we were happy to see patients simply respond to treatment - symptoms were ameliorated and the patient had few complaints. Now this level of improvement is insufficient. We need to attain total remission.
We need complete functional recovery.
Do you think that cognitive dysfunction can trigger new depressive episodes in the patients that you follow?
Certainly. Cognitive dysfunction makes patients function suboptimally. They don’t get to work, daily tasks are not done and relationships suffer. In fact, it’s a disability. Patients become unable to take decisions, their will is impaired as is their capacity to do things. All these are impaired.
Cognitive dysfunction is important in depression – we cannot neglect this symptomatology.
In my experience, cognitive dysfunction preceded depression and is the primary signal that there is a problem. I see patients with depression associated with cognitive dysfunction so often. In fact, I frequently receive referral of elderly ladies, say over the age of 70 years of age, who have been misdiagnosed with Alzheimer’s disease and dementia. After an examination, as many as 50% actually are presenting with major depression and cognitive dysfunction. This is significant because we can do something about it.
How can today’s treatments help your depressed patients with cognitive dysfunction?
We have new medicines that allow us to treat all aspects of the syndrome. We have augmentation strategies. These allow us to make pharmacotherapy more efficient. I believe that these new medicines are the future of effective depression management.