title: Influence of anxiety symptoms on improvement of neurocognitive functions in patients with major depressive disorder: A 12-week, multicenter, randomized trial of tianeptine versus escitalopram, the CAMPION study.
abstract: BACKGROUND
  Previous research has reported evidence that patients with major depressive disorder (MDD) show anxiety symptoms and neurocognitive impairments. However, the influence of anxiety on neurocognitive function in MDD patients during antidepressant treatment is unclear.
  
  
  METHODS
  MDD patients (n=164) completed a 12-week, multicenter, randomized trial assigned in a 1:1 ratio to either tianeptine or escitalopram. Changes of anxiety symptoms were assessed by the Hamilton Anxiety Rating Scale (HAM-A), and the Hamilton Depression Rating Scale (HAM-D), self-rated subjective cognitive impairment on memory and concentration, the Mini-Mental Status Examination (MMSE), Continuous Performance Test (CPT), Verbal Learning Test (VLT), and Raven's Progressive Matrices (RPM) were assessed every 4 weeks.
  
  
  RESULTS
  During 12 weeks of treatment, decrease in the HAM-A score was significantly associated with improvement of subjective cognitive impairments on memory (p<0.001) and concentration (p<0.001), and objective measures on delayed memory (p=0.006) and reasoning ability (p=0.002), after adjusting for covariates such as baseline HAM-A scores, time, sex, age, education years and assigned medication using the Mixed effects and Generalized Estimated Equation model analysis. However, the other cognitive outcome variables, immediate memory, commission error, and MMSE, which showed significant improvement through 12-week study period, showed no significant association with improvement of anxiety.
  
  
  CONCLUSIONS
  Improvement of anxiety symptoms was significantly associated with improvement in subjective and objective neurocognitive functions such as delayed memory and reasoning ability in elderly MDD patients during antidepressant treatment, but not significantly associated with improvement of immediate memory and commission error.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier NCT01309776.
authors.affiliation: Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Ikki
authors.initials: I
authors.lastname: Yoo
authors.affiliation: Department of Psychiatry, Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea.
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Woo
authors.affiliation: Department of Psychiatry, Ilsan Paik Hospital, Inje University School of Medicine, Ilsan, Korea.
authors.forename: Seung-Hwan
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: David
authors.initials: D
authors.lastname: Mischoulon
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: George I
authors.initials: GI
authors.lastname: Papakostas
authors.affiliation: Department of Psychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Korea.
authors.forename: Eui-Joong
authors.initials: EJ
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seockhoon
authors.initials: S
authors.lastname: Chung
authors.affiliation: Department of Psychiatry, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Jee Hyun
authors.initials: JH
authors.lastname: Ha
authors.affiliation: Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Clinical Research Design and Evaluation, and Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, Korea; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA. Electronic address: jeonhj@skku.edu.
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Jeon
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D015283:Citalopram / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D013841:Thiazepines / Q000627:therapeutic use*
chemical_list: D000928:Antidepressive Agents; D013841:Thiazepines; D015283:Citalopram; C050504:tianeptine
keywords: Antidepressant trial; Anxiety; Major depressive disorder; Neurocognition