治疗重度抑郁症认知症状的药理学方法。

Pharmacological Treatment of Cognitive Symptoms in Major Depressive Disorder.

机构信息

Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.

Institute of Medical Science, University of Toronto, Toronto, ON, Canada.

出版信息

CNS Neurol Disord Drug Targets. 2017;16(8):891-899. doi: 10.2174/1871527316666170919115100.

DOI:10.2174/1871527316666170919115100

PMID:28933261

Abstract

BACKGROUND

Cognitive dysfunction is a core transdiagnostic domain of Major Depressive Disorder (MDD) and is a principal determinant of functional recovery. However, it has been insufficiently targeted within the current therapeutic framework for MDD.

OBJECTIVE

To highlight these unmet cognitive needs in MDD.

METHOD

An article search was conducted using PubMed from inception to November 2016: Major Depressive Disorder (and/or variant) was cross-referenced with the following terms: antidepressants, augmentation, cognition, cognitive deficits, cognitive dysfunction, functional outcomes, mechanism of action, and treatment. Articles informed by observational studies, clinical trials, and review articles relevant to the discussion of cognition and cognitive impairment in MDD were included for review. Additional terms and citations previously not identified in the initial search were obtained from a manual review of article reference lists.

RESULTS

Cognitive deficits in MDD are replicable, non-specific, and clinically significant. Abnormalities in the domains of learning/memory, executive function, attention, concentration, and processing speed are consistently reported. Only two antidepressants (i.e., duloxetine and vortioxetine) have established procognitive effects utilizing rigorous methodology in MDD. Most antidepressants improve cognitive function(s), but the extent to which they directly exert pro-cognitive effects is not yet understood.

CONCLUSION

Cognitive dysfunction in MDD is a principal determinant of patient-reported outcomes (e.g., psychosocial function). Healthcare providers are encouraged to screen for cognitive dysfunction in MDD and familiarize themselves with the efficacy profiles of antidepressants on disparate cognitive domains.

摘要

背景

认知功能障碍是重度抑郁症（MDD）的核心跨诊断领域，也是功能恢复的主要决定因素。然而，在当前的 MDD 治疗框架中，它的针对性不足。

目的

强调 MDD 中这些未满足的认知需求。

方法

使用 PubMed 从创建到 2016 年 11 月进行了文章搜索：将“重度抑郁症（和/或变体）”与以下术语交叉引用：抗抑郁药、增效、认知、认知缺陷、认知功能障碍、功能结果、作用机制和治疗。纳入了与 MDD 中的认知和认知障碍讨论相关的观察性研究、临床试验和综述文章。从最初搜索中未识别出的其他术语和引文，从文章参考文献的手动审查中获得。

结果

MDD 中的认知缺陷是可复制的、非特异性的和具有临床意义的。学习/记忆、执行功能、注意力、集中力和处理速度等领域的异常情况经常被报道。只有两种抗抑郁药（即度洛西汀和文拉法辛）在 MDD 中利用严格的方法证明了具有认知促进作用。大多数抗抑郁药都能改善认知功能，但它们直接产生认知促进作用的程度尚不清楚。