title: Cognitive effects of pharmacotherapy for major depressive disorder: a systematic review.
abstract: OBJECTIVE
  Cognitive impairment frequently accompanies major depressive disorder (MDD) and can persist during remission. This review examined pharmacotherapy effects on cognitive function in MDD.
  
  
  METHODS
  PubMed and EMBASE searches were conducted on July 30, 2013, for English language reports of cognitive assessments following pharmacologic monotherapy or augmentation therapy in MDD.
  
  
  METHODS
  A total of 43 research reports were identified (31 monotherapy [8 placebo-controlled, 11 active-comparator, 12 open-label], 12 augmentation therapy [7 placebo-controlled, 5 open-label]).
  
  
  METHODS
  Results reported in each publication were examined for open-label and placebo- or active comparator-controlled studies.
  
  
  RESULTS
  Studies varied widely in terms of size (median, 50 participants; interquartile range, 21-143 participants), populations examined, duration (median, 8 weeks; interquartile range, 6-12 weeks), and neurocognitive assessments used. Most individual studies reported some benefit to cognition with pharmacotherapy, but there was no pattern of response in specific domains and only 12% of individually analyzed changes favored active treatment over placebo or untreated healthy controls. Sample weighted mean effect sizes revealed that verbal memory improved with monotherapy, while the largest treatment effect with augmentation therapy was for visual memory.
  
  
  CONCLUSIONS
  Pharmacotherapy may have benefit in reducing cognitive impairment in MDD, with augmentation therapy being a potential approach for addressing cognitive deficits that persist after monotherapy has brought about clinical response or remission. However, given the wide variability in study design and treatment duration across studies, these findings should be interpreted cautiously. More definitive research is required before firm conclusions can be reached.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Room 3425 Purple Zone, 200 Trent Drive, Box #3270 DUHS, Duke University Medical Center, Durham, NC 27710 richard.keefe@duke.edu.
authors.forename: Richard S E
authors.initials: RS
authors.lastname: Keefe
authors.forename: Shawn M
authors.initials: SM
authors.lastname: McClintock
authors.forename: Robert M
authors.initials: RM
authors.lastname: Roth
authors.forename: P Murali
authors.initials: PM
authors.lastname: Doraiswamy
authors.forename: Steven
authors.initials: S
authors.lastname: Tiger
authors.forename: Manisha
authors.initials: M
authors.lastname: Madhoo
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000150:complications / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D009483:Neuropsychological Tests; D011619:Psychotropic Drugs / Q000627:therapeutic use*
chemical_list: D000928:Antidepressive Agents; D011619:Psychotropic Drugs