a Discipline of Psychiatry , Adelaide Medical School, University of Adelaide , Adelaide , Australia.
b Department of Psychiatry and Psychotherapy , University Hospital Münster, University of Münster , Münster , Germany.
Expert Rev Neurother. 2019 May;19(5):431-443. doi: 10.1080/14737175.2019.1610395. Epub 2019 Apr 25.
Cognitive dysfunction is prevalent in patients with major depressive disorder (MDD), with deficits observed across several domains (e.g., executive function, memory, attention). While depression alone is disabling, patients with cognitive deficits typically experience greater functional impairments, poorer clinical recovery, and reduced quality of life. Consequently, it is imperative to elucidate recent advances in our understanding of the treatment of cognitive dysfunction in MDD. Areas covered: This review spans psychological, physical, and pharmacological treatment approaches for cognitive dysfunction in depression. Where possible, the authors summarise where treatments have demonstrated efficacy in improving specific cognitive domains (e.g., attention), and highlight the differential mechanisms which underpin cognitive improvement. In addition, the roles of adjunctive cognitive treatments (e.g., exercise), and the possible side effects and drawbacks of specific treatments are explored. Expert opinion: Psychological treatments typically confer cognitive improvement alongside functional and/or clinical recovery; however, the efficacy of cognitive training and cognitive behavioral therapy to longitudinal cognitive improvement remains to be established. Recently developed pharmacological agents may improve cognition by reducing low-grade inflammation and promoting neurogenesis; however, the pro-cognitive effects of typical antidepressants are limited. Integrated approaches which emphasize cognitive recovery alongside clinical and functional improvement may be key to advancing patient outcomes.
认知功能障碍在重度抑郁症（MDD）患者中很常见，在多个领域（如执行功能、记忆、注意力）都存在缺陷。尽管单独的抑郁已经很使人衰弱了，但有认知缺陷的患者通常会经历更大的功能障碍、更差的临床恢复和更低的生活质量。因此，阐明我们对 MDD 认知功能障碍治疗的理解的最新进展是至关重要的。
这篇综述涵盖了抑郁症认知功能障碍的心理、生理和药理学治疗方法。在可能的情况下，作者总结了哪些治疗方法在改善特定认知领域（如注意力）方面具有疗效，并强调了认知改善的基础的不同机制。此外，还探讨了辅助认知治疗（如运动）的作用，以及特定治疗方法可能的副作用和缺点。
心理治疗通常会在功能和/或临床恢复的同时改善认知；然而，认知训练和认知行为疗法对纵向认知改善的疗效仍有待确定。最近开发的药物可能通过减少低度炎症和促进神经发生来改善认知；然而，典型抗抑郁药的认知促进作用是有限的。强调认知恢复与临床和功能改善相结合的综合方法可能是改善患者预后的关键。
