title: Executive performance of depressed suicide attempters: the role of suicidal ideation Auditory-verbal declarative and operating memory among patients suffering from depressive disorders - preliminary study. Antidepressants and cognition: comparative effects of moclobemide, viloxazine and maprotiline Antidepressive therapy with escitalopram improves mood, cognitive symptoms, and identity memory for angry faces in elderly depressed patients. Effect of Sahaj Yoga on neuro-cognitive functions in patients suffering from major depression. Durability of cognitive remediation training in schizophrenia: performance on two memory tasks at 6-month and 12-month follow-up Differential efficacy of escitalopram and nortriptyline on dimensional measures of depression. Diminished Neural Processing of Aversive and Rewarding Stimuli During Selective Serotonin Reuptake Inhibitor Treatment Clinical and Neurobiological Effects of Tianeptine and Paroxetine in Major Depression The SSRIs drug Fluoxetine, but not the noradrenergic tricyclic drug Desipramine, improves memory performance during acute major depression Neurocognitive enhancement therapy with work therapy: effects on neuropsychological test performance. Persistence of cognitive impairment in geriatric patients following antidepressant treatment: a randomized, double-blind clinical trial with nortriptyline and paroxetine. A randomized single-blind pilot study of compensatory strategies in schizophrenia outpatients. Citalopram versus sertraline in late-life nonmajor clinically significant depression: a 1-year follow-up clinical trial. Effect of acute antidepressant administration on negative affective bias in depressed patients. Escitalopram and enhancement of cognitive recovery following stroke. Does antidepressant therapy improve cognition in elderly depressed patients? Improvement of working but not declarative memory is correlated with HPA normalization during antidepressant treatment. The role of CBT in explicit memory bias in bipolar I patients. RESEARCH: Cognitive Rehabilitation for Bipolar Disorder: An Open Trial for Employed Patients with Residual Depressive Symptoms Acute and long-term treatment of late-life major depressive disorder: duloxetine versus placebo. Effects of selective serotonin reuptake and dual serotonergic-noradrenergic reuptake treatments on memory and mental processing speed in patients with major depressive disorder. Successful computer-assisted cognitive remediation therapy in patients with unipolar depression: a proof of principle study. The effects of high-dose and low-dose tryptophan depletion on mood and cognitive functions of remitted depressed patients Tianeptine therapy for depression in the elderly Combined cognitive remediation and functional skills training for schizophrenia: effects on cognition, functional competence, and real-world behavior. A double blind, placebo-controlled pilot study of galantamine augmentation of antidepressant treatment in older adults with major depression. Changes in cognitive functioning following treatment of late-life depression. Efficacy of duloxetine on cognition, depression, and pain in elderly patients with major depressive disorder: an 8-week, double-blind, placebo-controlled trial. Comparison of sertraline and nortriptyline in the treatment of major depressive disorder in late life. The normalisation of disrupted attentional processing of infant distress in depressed pregnant women following Cognitive Behavioural Therapy. Cognitive remediation of working memory deficits: durability of training effects in severely impaired and less severely impaired schizophrenia A randomized, double-blind, placebo-controlled, duloxetine-referenced, fixed-dose study comparing the efficacy and safety of Lu AA21004 in elderly patients with major depressive disorder Randomized double-blind placebo-controlled donepezil augmentation in antidepressant-treated elderly patients with depression and cognitive impairment: a pilot study. Cognitive training in affective disorders improves memory: a preliminary study using the NEAR approach. Changes in Automatic Threat Processing Precede and Predict Clinical Changes with Exposure-Based Cognitive-Behavior Therapy for Panic Disorder A twelve-week randomized controlled study of the cognitive-behavioral Integrated Psychological Therapy program: positive effect on the social functioning of schizophrenic patients. Assessment of depressive symptoms and functional outcomes in patients with major depressive disorder treated with duloxetine versus placebo: primary outcomes from two trials conducted under the same protocol. Effects of S-adenosylmethionine augmentation of serotonin-reuptake inhibitor antidepressants on cognitive symptoms of major depressive disorder. Memory impairment in patients with late-onset major depression: the effect of antidepressant therapy.
abstract: ObjectiveS uicidal ideation has been related to cognitive rigidity whereas suicidal behaviour itself was associated with specific executive deficits . Yet it remains unclear if a distinct cognitive suicidal phenotype does exist . The aim of the present study was to further investigate the role of suicidal thinking for the neuropsychological performance in depressive suicide attempters . Method Depressive in patients after a recent suicide attempt , who either had present suicidal ideation ( n = 14 ) or not ( n = 15 ) and healthy controls ( n = 29 ) were recruited . The groups were assessed by means of executive tasks design ed to capture impulsive decision-making , and with verbal memory and attention tests . Self-rating measures of impulsivity and aggression  were further applied . Results Only patients with current suicidal ideation showed executive dysfunctions with impaired decision-making being the most salient . Verbal memory and attention were reasonably intact in all patients . All patients reported increased aggression . ConclusionS uicidal ideation is clearly associated with impaired cognitive performance . Our results suggest that executive deficits seen in depressive suicide attempters have a state-dependent component PURPOSE Dysfunctions of auditory-verbal declarative and working memory are observed in patients with depressive disorders ( DD ) . The authors wanted to see , whether antidepressive therapy improved the efficiency of cognitive processes among patients suffering from DD and determine possible associations between auditory-verbal declarative and working memory performance , evaluated before treatment vs. remission degree after treatment . MATERIAL AND METHODS The study was carried out in 87 subjects , patients with depressive disorders ( n=30 , DD ) and healthy subjects ( n=57 , CG , control group ) . The  AVLT ( Auditory Verbal Learning Test )  and the  Stroop Test  were used . RESULTS CG obtained higher results vs. DD-I ( the evaluation started on the therapy onset ) in the Stroop Test-RCNb ( Reading Colour Names in Black)/time , NCWd ( Naming Colour of Word - Different)/time , NCWd/errors , AVLT : the number of words after 30 minutes . CG demonstrated higher results than DD-II ( following eight weeks of pharmacological treatment ) in RCNb/time , NCWd/time , AVLT : the number of words in the first trial , the number of words after 30 minutes . Compared to DD-I , DD-II achieved better results in NCWd/errors . No statistically significant differences were observed in both tests between the patients with remission and without remission . Statistical analysis revealed the lack of significant dependences among HDRS after treatment and cognitive functions before treatment . CONCLUSIONS Depressive disorders are associated with deteriorated efficiency of auditory-verbal declarative and working memory . No improvement was observed in the efficiency of auditory-verbal declarative or working memory after 8-week therapy . The performance level of cognitive processes before pharmacotherapy has no effect on the intensity of depression symptoms after therapy The respective effects of three antidepressant drugs ( moclobemide , 450 mg/j ; viloxazine , 300 mg/j ; maprotiline , 150 mg/j ) on vigilance , attention , and memory were compared . Young depressed out patients ( n=46 ) entered a double-blind , r and omised , monocentre clinical trial lasting for 6 weeks . Drug actions were assessed through the regular determination of critical flicker fusion point ( CFF ) , reaction times ( SRT ) , and a battery to measure memory components . None of the three drugs caused deterioration in cognitive functions . On the other h and , moclobemide improved both vigilance and attention ( CFF , SRT ) and some crucial components of memory ( general memory scores , delayed word recall , recognition of familiar faces ) . This effect was rapid , stable , and superior to those of viloxazine and maprotiline . It may be explained by moclobemide 's selective and reversible inhibition of monoamine oxidase A , as well as by the lack of any anticholinergic action Depression is a common disorder in the elderly h and icapping patients with affective and cognitive symptoms . Because of their good tolerability relative to the older tricyclic compounds , selective serotonin reuptake inhibitors ( SSRIs ) are increasingly used for the treatment of depression in the elderly . Little is known about their effects on cognition in elderly patients . In the present 4-wk , single-centre , r and omized , open-label trial we investigated the antidepressive effects of escitalopram , an SSRI , in 18 elderly depressed patients [ mean age ( + /-s.e.m . ) 76.2+/-1.8 yr ] compared to 22 healthy age-matched controls ( mean age 76.9+/-1.8 yr ) . Affective and cognitive symptoms were assessed using the Geriatric Depression Scale ( GDS ) , Mini-Mental State Examination ( MMSE ) , and a face portrait recognition test to assess memory for happy and angry faces .  Depressed patients prior to treatment had markedly reduced memory performance . Treatment with escitalopram improved affective and cognitive symptoms significantly . Furthermore , escitalopram treatment improved memory for negative facial stimuli .  Control subjects confirmed the well- established memory bias favouring recognition of identities acquired with happy expressions . Importantly , this bias was absent in depressed patients prior to , but also after treatment . In conclusion , escitalopram , even after a relatively short treatment period , was effective in treating  depression in the elderly and may help improve cognitive performance for social stimuli Cognitive functions are impaired in Major Depression . Studies on the effects of Yoga on cognitive functions have shown improvement in memory , vigilance and anxiety levels . 30 patients suffering from Major depression ( age 18 to 45 years ) were r and omly divided into two groups : Group 1 : ( 10 males and 5 Females ) Patients who practised Sahaj Yoga meditation and also received conventional anti-depressant medication . Group 2 : ( 9 males and 6 Females ) Patients who only received conventional antidepressant medication .  Group 1 patients were administered Sahaj Yoga practice for 8 weeks . Neuro-cognitive test battery consisting of Letter cancellation test ( LCT ) , Trail making test ' A ' ( TTA ) , Trail making test ' B ' ( TTB ) , Ruff figural fluency test ( RFFT ) , Forward digit span ( FDS ) & Reverse digit span test ( RDS ) was used to assess following cognitive domains : Attention span , visuo-motor speed , short-term memory , working memory and executive functions . After 8 weeks , both Group 1 and Group 2 subjects showed significant improvement in LCT , TTA & TTB but improvement in LCT was more marked in Group 1 subjects . Also , there was significant improvement in RDS scores in only Group 1 subjects ( P < 0.05 ) . The results thereby , demonstrate that Sahaj Yoga practice in addition to the improvement in various other cognitive domains seen with conventional anti-depressants , can lead to additional improvement in executive functions like manipulation of information in the verbal working memory and added improvement in attention span and visuo-motor speed of the depressives Patients with schizophrenia have consistently been found to exhibit cognitive deficits , particularly in memory , which have been suggested to mediate functional outcomes . Several recent review s of cognitive retraining have concluded that these deficits respond to training , although the sustainability of cognitive improvement following completion of training has not been adequately evaluated . Most studies had small sample s and very short follow-up periods . As part of a larger study , we examined performance on two memory tasks in two groups of participants : those who received computerized cognitive remediation training in addition to work therapy ( n=45 ) , vs. those who only received work therapy ( n=49 ) .  Computerized cognitive remediation included hierarchical training on a computerized digit span task and a computerized words serial position task . Assessment s using the same computerized tasks were made at three time points : baseline , end of active intervention , and 6-month follow-up . Compared to the active control condition ( work therapy only ) , the group receiving computerized cognitive remediation in addition to work therapy showed significantly greater improvements on the trained digit span task following training . These improvements were maintained at the 6-month follow-up . There were no significant group differences on the word serial position task at any time point . Results indicate that computerized training can lead to sustained improvements on some , but not all , training tasks BACKGROUND Tricyclic antidepressants and serotonin reuptake inhibitors are considered to be equally effective , but differences may have been obscured by internally inconsistent measurement scales and inefficient statistical analyses . AIMS To test the hypothesis that escitalopram and nortriptyline differ in their effects on observed mood , cognitive and neurovegetative symptoms of depression . METHOD In a multicentre part-r and omised open-label design ( the Genome Based Therapeutic Drugs for Depression ( GENDEP ) study ) 811 adults with moderate to severe unipolar depression were allocated to flexible dosage escitalopram or nortriptyline for 12 weeks . The weekly Montgomery-Asberg Depression Rating Scale , Hamilton Rating Scale for Depression , and Beck Depression Inventory were scored both conventionally and in a more novel way according to dimensions of observed mood , cognitive symptoms and neurovegetative symptoms . RESULTS Mixed-effect linear regression showed no difference between escitalopram and nortriptyline on the three original scales , but symptom dimensions revealed drug-specific advantages . Observed mood and cognitive symptoms improved more with escitalopram than with nortriptyline .  Neurovegetative symptoms improved more with nortriptyline than with escitalopram . CONCLUSIONS The three symptom dimensions provided sensitive descriptors of differential antidepressant response and enabled identification of drug-specific effects Background Selective serotonin reuptake inhibitors ( SSRIs ) are popular medications for anxiety and depression , but their effectiveness , particularly in patients with prominent symptoms of loss of motivation and pleasure , has been question ed . There are few studies of the effect of SSRIs on neural reward mechanisms in humans . Methods We studied 45 healthy participants who were r and omly allocated to receive the SSRI citalopram , the noradrenaline reuptake inhibitor reboxetine , or placebo for 7 days in a double-blind , parallel group design . We used functional magnetic resonance imaging to measure the neural response to rewarding ( sight and /or flavor of chocolate ) and aversive stimuli ( sight of moldy strawberries and /or an unpleasant strawberry taste ) on the final day of drug treatment . Results Citalopram reduced activation to the chocolate stimuli in the ventral striatum and the ventral medial/orbitofrontal cortex . In contrast , reboxetine did not suppress ventral striatal activity and in fact increased neural responses within medial orbitofrontal cortex to reward . Citalopram also decreased neural responses to the aversive stimuli conditions in key “ punishment ” areas such as the lateral orbitofrontal cortex . Reboxetine produced a similar , although weaker effect . Conclusions Our findings are the first to show that treatment with SSRIs can diminish the neural processing of both rewarding and aversive stimuli . The ability of SSRIs to decrease neural responses to reward might underlie the question ed efficacy of SSRIs in depressive conditions characterized by decreased motivation and anhedonia and could also account for the experience of emotional blunting described by some patients during SSRI treatment Selective serotonin reuptake inhibitors ( SSRIs ) are widely used as effective pharmacological agents to treat depressive disorders . In contrast to the SSRIs , which block the presynaptic serotonin ( 5-HT ) transporter and by this route increase the concentration of serotonin in the synaptic cleft , the antidepressant tianeptine enhances the presynaptic neuronal reuptake of 5-HT and thus decreases serotonergic neurotransmission . Both SSRIs and tianeptine are clinical ly effective ; however , their opposite modes of action challenge the prevailing concepts on the need of enhancement of serotonergic neurotransmission . To better underst and the differences between these two opposite pharmacological modes of action , we compared the changes induced by tianeptine and paroxetine on psychopathology , the hypothalamic-pituitary-adrenocortical ( HPA ) system , and cognitive functions in a double-blind , r and omized , controlled trial including 44 depressed in patients over a period of 42 days .  Depressive symptomatology significantly improved in all efficacy measures , with no significant differences between tianeptine and paroxetine . There was a trend toward better response to the SSRI among women . Assessment of the HPA system showed marked hyperactivity before the beginning of treatment , which then normalized in most of the patients , without significant differences between the two antidepressants . Cognitive assessment s showed no significant differences between the two drugs investigated . The results of the current study suggest that the initial effect , i.e. , enhancement or decrease of 5-HT release , is only indirectly responsible for antidepressant efficacy , and they support the notion that downstream adaptations within and between nerve cells are crucial . The normalization of the HPA system as a common mode of action of different antidepressants seems to be of special interest Accumulating evidence suggests that noradrenergic and serotonergic drugs are equally effective in ameliorating the depressive symptoms of major depression . Major depression is associated also with memory impairments , but the comparative effects of the antidepressant drugs on memory are not clear . We previously found that serotonergic neurotransmission is of particular importance for some aspects of episodic memory . We set out to test whether treatment with the selective serotonergic drug Fluoxetine ( Prozac ) would be advantageous in this respect over treatment with the selective noradrenergic tricyclic antidepressant drug Desipramine ( Deprexan ) .  Seventeen patients with major depressive episode , r and omly assigned for treatment with either Fluoxetine ( n = 8) or Desipramine ( n = 9 ) , were assessed for their clinical situation and for memory performance at the beginning of treatment , after 3 weeks , and after 6 weeks of pharmacological treatment . We found that although clinical ly both drugs were equally effective , the improvement of memory performance in the Fluoxetine-treated patients was significantly greater compared with that of the Desipramine-treated patients . The results support the role of serotonin in memory . More studies in larger sample s of patients are required , but it may be that in cases where memory impairment is a major symptom , it would be beneficial to consider serotonergic antidepressant drugs for treatment . Furthermore , in cases where , for various reasons , the treatment of choice is noradrenergic , it may be worthwhile to consider a supplementary serotonergic drug to improve memory deficits BACKGROUND Cognitive deficits are a major determinant of social and occupational dysfunction in schizophrenia . In this study , we determined whether neurocognitive enhancement therapy ( NET ) in combination with work therapy ( WT ) would improve performance on neuropsychological tests related to but different from the training tasks . METHODS Sixty-five patients with schizophrenia or schizoaffective disorder were r and omly assigned to NET plus WT or WT alone . Neurocognitive enhancement therapy included computer-based training on attention , memory , and executive function tasks ; an information processing group ; and feedback on cognitive performance in the workplace . Work therapy included paid work activity in job placements at the medical center ( eg , mail room , grounds , library ) with accompanying supports .  Neuropsychological testing was performed at intake and 5 months later . RESULTS Prior to enrollment , both groups did poorly on neuropsychological testing . Patients receiving NET + WT showed greater improvements on pretest-posttest variables of executive function , working memory , and affect recognition . As many as 60 % in the NET + WT group improved on some measures and were 4 to 5 times more likely to show large effect-size improvements . The number of patients with normal working memory performance increased significantly with NET + WT , from 45 % to 77 % , compared with a decrease from 56 % to 45 % for those receiving WT . CONCLUSIONS Computer training for cognitive dysfunction in patients with schizophrenia can have benefits that generalize to independent outcome measures . Efficacy may result from a synergy between NET , which encourages mental activity , and WT , which allows a natural context for mental activity to be exercised , generalized , and reinforced Cognitive dysfunction is common in older persons suffering from a major depression . However , the degree to which this dysfunction is reversible with successful treatment of the depression remains uncertain . The present study examined the effects that treatment ( r and omized double-blind design ) with either an SSRI ( paroxetine ) or a tricyclic antidepressant ( nortriptyline ) had on cognition in older depressed patients . The patients ' performance was compared to that of a group of normal controls of similar age and education . Patients and controls were administered measures of working memory , information-processing speed , episodic memory and attention five times over the course of a 12 week trial . At baseline , the patients performed more poorly than the elderly controls on all cognitive measures . While the patients ' performance did improve over the course of their treatment , the magnitude of this improvement did not exceed that produced in the elderly controls by practice alone . The same pattern of results was evident in both intent-to-treat and responder analyses . Thus , there was no evidence that the depressed patients ' cognitive performance normalized after response to antidepressant therapy . Neither the patients ' age at onset nor their baseline level of cognitive functioning influenced the amount by which their performance improved over the 12 week trial . There was no difference between paroxetine and nortriptyline in the amount of cognitive change associated with treatment . The present results suggest that cognitive dysfunction persists in older depressed patients even after their mood disorder has responded to antidepressant medications In a previous study , we found that cognitive adaptation training (CAT)--a manual-driven program of environmental supports design ed to bypass cognitive deficits -- improved multiple domains of outcome in schizophrenia patients recently discharged from a State psychiatric facility . The present study examined the efficacy of CAT in a sample of patients who had been in the community at least 3 months . Forty-five medicated schizophrenia patients were r and omly assigned for 9 months to one of three conditions : ( 1 ) CAT , ( 2 ) a condition that controlled for therapist time and provided environmental changes unrelated to cognitive deficits , or ( 3 ) follow-up only . Comprehensive assessment s were conducted every 3 months by blinded raters . Results of repeated measures analyses of covariance for mixed models indicated that patients participating in CAT had better adaptive function and quality of life , and fewer positive symptoms than those in the two non-CAT conditions . Results indicate that compensatory strategies may improve various outcomes in schizophrenia out patients OBJECTIVE The aim of this study was to compare over 1 year the effect of sertraline and citalopram on depressive symptoms and cognitive functions of nondemented elderly patients with minor depressive disorder and subsyndromal depressive symptomatology . METHOD We recruited 138 consecutive non-demented out patients of either sex , aged > or = 65 years , who were classified as meeting research criteria for minor depressive disorder or sub-syndromal depressive symptomatology using the Structured Clinical Interview for DSM-IV . Subjects were assigned to receive citalopram 20 mg/day ( 66 patients ) or sertraline 50 mg/day ( 72 patients ) orally for 1 year . Patients were assessed at baseline and after 1 , 2 , 3 , and 6 months and at 1 year by raters masked with regard to patients ' treatment assignments . The Hamilton Rating Scale for Depression , the Geriatric Depression Scale , and the Global Assessment of Functioning were administered to assess the course of depressive symptoms and social functioning during the study . Cognitive measures included Trail Making Test-Parts A and B , Wechsler Memory Scale , Mini-Mental State Examination , and a verbal fluency test . Data were collected from March 2000 to March 2003 . RESULTS The overall completion rate was 72 % . Both treatments induced a significant , sustained , and comparable improvement in depressive symptoms and in social functioning . Nearly half of the subjects in the 2 groups achieved remitter status at study endpoint . Significant within-group improvements also were observed in all cognitive measures . Both drugs were well tolerated during the whole study period . CONCLUSION Our results suggest that sertraline and citalopram can improve depressive symptoms and cognitive functions of minor depressive disorder and subsyndromal depressive symptomatology in elderly nondemented patients OBJECTIVE Acute administration of an antidepressant increases positive affective processing in healthy volunteers , an effect that may be relevant to the therapeutic actions of these medications . The authors investigated whether this effect is apparent in depressed patients early in treatment , prior to changes in mood and symptoms . METHOD In a double-blind , placebo-controlled , between-groups r and omized design , the authors examined the effect of a single 4-mg dose of the norepinephrine reuptake inhibitor reboxetine on emotional processing . Thirty-three depressed patients were recruited through primary care clinics and the community and matched to 31 healthy comparison subjects . Three hours after dosing , participants were given a battery of emotional processing tasks comprising facial expression recognition , emotional categorization , and memory . Ratings of mood , anxiety , and side effects were also obtained before and after treatment . RESULTS Depressed patients who received placebo showed reduced recognition of positive facial expressions , decreased speed in responding to positive self-relevant personality adjectives , and reduced memory for this positive information compared to healthy volunteers receiving placebo . However , this effect was reversed in patients who received a single dose of reboxetine , despite the absence of changes in subjective ratings of mood or anxiety . CONCLUSIONS Antidepressant drug administration modulates emotional processing in depressed patients very early in treatment , before changes occur in mood and symptoms . This effect may ameliorate the negative biases in information processing that characterize mood and anxiety disorders . It also suggests a mechanism of action compatible with cognitive theories of depression CONTEXT Adjunctive restorative therapies administered during the first few months after stroke , the period with the greatest degree of spontaneous recovery , reduce the number of stroke patients with significant disability . OBJECTIVE To examine the effect of escitalopram on cognitive outcome . We hypothesized that patients who received escitalopram would show improved performance in neuropsychological tests assessing memory and executive functions than patients who received placebo or underwent Problem Solving Therapy . DESIGN R and omized trial . SETTING Stroke center . PARTICIPANTS One hundred twenty-nine patients were treated within 3 months following stroke . The 12-month trial included 3 arms : a double-blind placebo-controlled comparison of escitalopram ( n = 43 ) with placebo ( n = 45 ) , and a nonblinded arm of Problem Solving Therapy ( n = 41 ) . OUTCOME MEASURES Change in scores from baseline to the end of treatment for the Repeatable Battery for the Assessment of Neuropsychological Status ( RBANS ) and Trail-Making , Controlled Oral Word Association , Wechsler Adult Intelligence Scale-III Similarities , and Stroop tests . RESULTS We found a difference among the 3 treatment groups in change in RBANS total score ( P < .01 ) and RBANS delayed memory score ( P < .01 ) . After adjusting for possible confounders , there was a significant effect of escitalopram treatment on the change in RBANS total score ( P < .01 , adjusted mean change in score : escitalopram group , 10.0 ; nonescitalopram group , 3.1 ) and the change in RBANS delayed memory score ( P < .01 , adjusted mean change in score : escitalopram group , 11.3 ; nonescitalopram group , 2.5 ) . We did not observe treatment effects in other neuropsychological measures . CONCLUSIONS When compared with patients who received placebo or underwent Problem Solving Therapy , stroke patients who received escitalopram showed improvement in global cognitive functioning , specifically in verbal and visual memory functions . This beneficial effect of escitalopram was independent of its effect on depression . The utility of antidepressants in the process of poststroke recovery should be further investigated . Trial Registration clinical trials.gov Identifier : NCT00071643 OBJECTIVES To analyze the effects of antidepressants on cognitive functioning in elderly depression . METHODS Data were pooled for elderly participants with major depression from two double-blind 12-week studies ( n = 444 ) comparing sertraline to fluoxetine and to nortriptyline . A cognitive battery was performed pre-treatment and post-treatment that included the Shopping List Task ( SLT ) , which quantifies short-term and long-term memory storage and retrieval , and the Digit Symbol Substitution Test ( DSST ) , which measures visual tracking , motor performance , and coding . RESULTS Older age , male gender , higher systolic blood pressure , and higher illness severity were associated with lower performance on specific cognitive measures at baseline . For the entire group , improved depression and a lower anticholinergic side effect ( dry mouth and constipation ) severity were associated with statistically significant improvement in the SLT and DSST . The correlations between improvements in depression and improvement in tested cognitive function were highest for sertraline followed by nortriptyline and then fluoxetine . CONCLUSIONS Acute improvement in depression is associated with cognitive improvement as measured by the SLT and DSST . Prospect i ve studies are warranted to study the effects of potential differences among antidepressant therapies on long-term cognitive outcomes in geriatric depression Previous research demonstrated that depression is associated with hyperactivity of the hypothalamus-pituitary-adrenocortical ( HPA ) system after stimulation . There is also strong evidence that the modulation of corticosteroids in the brain induces memory dysfunction which represents core features of depression . Antidepressant treatment with serotonin reuptake inhibitors ( SSRIs ) alleviates both dysfunctions . Thus , these previous observations propose a correlation between treatment induced changes of the endocrinological response of the HPA system to challenge with dexamethasone and CRH and changes of memory functions during antidepressant treatment . This study explores the relationship between depression , memory functions and the responsiveness of the HPA system as assessed by the combined DEX/CRH test during antidepressant treatment in n = 64 patients with major depression during a four weeks treatment with citalopram .  We found that treatment induced changes of the cortisol response pattern in the DEX/CRH test were correlated with improvement of working memory but not so with episodic memory , sustained attention or global severity of depression . We suggest that improvement of working memory is more sensitive to the changes of hormones of the HPA system ( e.g. cortisol ) than other cognitive functions and the global severity of depression BACKGROUND AND OBJECTIVES Cognitive and Behavioural Therapy ( CBT ) is widely used in bipolar disorder , but recent meta-analyses showed that its impact is either of limited effect or not significant for important aspects such as recurrence rate . A possible benefit of CBT could concern cognitive functions , known to be frequently impaired in patients with bipolar disorder . We analysed if the positive impact of 6 months group-CBT was associated with the improvement of a specific cognitive function , namely explicit memory , trying to disentangle if memory bias ( i.e. different capacity according to the emotional valence of words to be recalled ) was more improved than memory performance ( i.e. , total number of recalled words ) . METHODS Depressive , manic , anxiety symptoms and explicit memory for emotional words were initially assessed in 68 remitted bipolar I patients . Six months later , with an attrition rate of 16.2 % , patients were re-assessed after CBT ( N = 42 ) or as control condition ( waiting list , N = 15 ) . The expected impact of CBT was assessed through the improvement in the Dysfunctional Attitudes Scale . RESULTS After CBT , an increase was observed for the number of neutral , positive and total words recalled , whereas the number of negative words recalled decreased . This increase was still significant when the improvement of dysfunctional attitudes and mood symptoms are taken into account . LIMITATIONS The small sample of control patients . CONCLUSIONS CBT was effective , as it improved dysfunctional attitudes and reduced remaining symptoms , but also , and independently , it improved explicit memory performance while reducing memory bias in favour of negative words Bipolar disorder is characterized by recurrent episodes of depression and /or mania along with interepisodic mood symptoms that interfere with psychosocial functioning . Despite periods of symptomatic recovery , individuals with bipolar disorder often continue to experience impairments in psychosocial functioning , particularly occupational functioning . Two determinants of psychosocial functioning of euthymic ( neither fully depressed nor manic ) individuals with bipolar disorder are residual depressive symptoms and cognitive impairment ( i.e. , difficulties with executive functioning , attention , and memory ) . The present study explored whether a new cognitive remediation ( CR ) treatment design ed to treat residual depressive symptoms and , for the first time to the best of our knowledge , address cognitive impairment would be associated with improvement in psychosocial functioning in individuals with bipolar disorder . Following a neuropsychological and clinical assessment 18 individuals with DSM‐IV bipolar disorder were treated with 14 individual sessions of CR . Results indicated that at the end of treatment , as well as at the 3‐months follow‐up , patients showed lower residual depressive symptoms , and increased occupational , as well as overall psychosocial functioning . Pretreatment neuropsychological impairment predicted treatment response . Improvements in executive functioning were associated with improvements in occupational functioning . These findings suggest that treating residual depressive symptoms and cognitive impairment may be an avenue to improving occupational and overall functioning in individuals with bipolar disorder OBJECTIVE To compare the efficacy of duloxetine with placebo on depression in elderly patients with major depressive disorder . DESIGN Multicenter , 24-week ( 12-week short-term and 12-week continuation ) , r and omized , placebo-controlled , double-blind trial . SETTING United States , France , Mexico , Puerto Rico . PARTICIPANTS Age 65 years or more with major depressive disorder diagnosis ( one or more previous episode ) ; Mini-Mental State Examination score ≥20 ; Montgomery-Asberg Depression Rating Scale total score ≥20 .  INTERVENTION Duloxetine 60 or 120 mg/day or placebo ; placebo rescue possible . MEASUREMENTS Primary -Maier subscale of the 17-item Hamilton Depression Rating Scale ( HAMD-17 ) at week 12 . Secondary -Geriatric Depression Scale , HAMD-17 total score , cognitive measures , Brief Pain Inventory ( BPI ) , Numeric Rating Scales ( NRS ) for pain , Clinical Global Impression-Severity scale , Patient Global Impression of Improvement in acute phase and acute plus continuation phase of treatment . RESULTS Compared with placebo , duloxetine did not show significantly greater improvement from baseline on Maier subscale at 12 weeks , but did show significantly greater improvement at weeks 4 , 8 , 16 , and 20 . Similar patterns for Geriatric Depression Scale and Clinical Global Impression-Severity scale emerged , with significance also seen at week 24 . There was a significant treatment effect for all BPI items and 4 of 6 NRS pain measures in the acute phase , most BPI items and half of the NRS measures in the continuation phase . More duloxetine-treated patients completed the study ( 63 % versus 55 % ) . A significantly higher percentage of duloxetine-treated patients versus placebo discontinued due to adverse event ( 15.3 % versus 5.8 % ) . CONCLUSIONS Although the antidepressant efficacy of duloxetine was not confirmed by the primary outcome , several secondary measures at multiple time points suggested efficacy . Duloxetine had significant and meaningful beneficial effects on pain Patients with major depressive disorder ( MDD ) usually suffer from altered cognitive functions of episodic memory , working memory , mental processing speed and motor response . Diverse studies suggest that different antidepressant agents may improve cognitive functions in patients with MDD . The aim of this work is to study the effects of serotonergic reuptake inhibitors ( SSRIs ) and serotonergic-noradrenergic reuptake inhibitors ( SNRIs ) treatments to improve the performance on memory tasks and mental processing speed in MDD . Seventy-three subjects meeting criteria for major depressive disorder were assessed with the Hamilton depression rating scale and a neuropsychological battery . The subjects were medicated with escitalopram ( n=36 ) or duloxetine ( n=37 ) for 24 weeks . At the end of the trial , the subjects were assessed again with the same neuropsychological battery used prior to the treatment . Both treatments improved importantly the episodic memory and to a lesser extent , working memory , mental processing speed and motor performance . Our results suggest that cognition is partially independent from improvement in clinical symptoms . Both groups achieved remission rates in the HAM-D-17 after 24 weeks of treatment , but SNRI was superior to SSRI  at improving episodic and working memory . Our work indicates that the superiority of SNRI over the SSRI  at episodic memory improvement is clinical ly relevant BACKGROUND Despite increasing awareness of the extent and severity of cognitive deficits in major depressive disorder ( MDD ) , trials of cognitive remediation have not been conducted . We conducted a 10-week course of cognitive remediation in patients with long-term MDD to probe whether deficits in four targeted cognitive domains , ( i ) memory , ( ii ) attention , ( iii ) executive functioning and ( iv ) psychomotor speed , could be improved by this intervention . METHOD We administered a computerized cognitive retraining package ( PSSCogReHab ) with demonstrated efficacy to 12 stable patients with recurrent MDD . Twelve matched patients with MDD and a group of healthy control participants were included for comparison ; neither comparator group received the intervention that involved stimulation of cognitive functions through targeted , repetitive exercises in each domain . RESULTS Patients who received cognitive training improved on a range of neuropsychological tests targeting attention , verbal learning and memory , psychomotor speed and executive function . This improvement exceeded that observed over the same time period in a group of matched comparisons . There was no change in depressive symptom scores over the course of the trial , thus improvement in cognitive performance occurred independent of other illness variables . CONCLUSIONS These results provide preliminary evidence that improvement of cognitive functions through targeted , repetitive exercises is a viable method of cognitive remediation in patients with recurrent MDD It has frequently been demonstrated that acute tryptophan depletion ( ATD ) induces a transient depressed mood in some patients who are in remission from depression . However , the effects of ATD on cognitive processes in remitted depressed patients have not been investigated . The aim of the present study was to investigate the effects of different extents of depletion on mood and cognitive tasks involving neutral and emotional stimuli . Twenty patients in remission or in partial remission from depression received ATD in a double-blind , crossover design . Mood was assessed at both sessions before , at + 6.5 h and + 24 h afterdepletion . Cognitive assessment in both sessions started at + 4.75 h , and also before and after the whole procedure . The ATD mixtures induced the expected reductions of plasma tryptophan levels . High-dose ATD induced a depressive response in a sub sample of patients and impaired theprocessing of positive information independent of mood change . Attention for neutral stimuli ( Stroop interference ) improved in a dose-dependent manner . ATD may affect mood and cognition via different pathways : one implicated in mood regulation and the processing ofemotional information , and one for the processing of neutral information . The first pathway may be more important for discriminating vulnerability to impaired serotonin function . The comparison of the effects of high-dose and low-dose ATD is useful for those studies aim ing to investigate the relationships among 5-HT , mood and cognition 1 . Depression is frequent in the elderly but difficult both to diagnose and treat due to a number of distinctive features . 2 . Tianeptine is a novel antidepressant with a reverse mode of action to that of the selective serotonin reuptake inhibitors yet with proven efficacy and safety . 3 . 63 elderly patients ( mean age:68.8 years ; range:65 - 80 years ) with depressive symptoms ( major depression:55.6 % ; dysthymia:44.4 % ) were included in a 3-month open multicenter study with tianeptine ( 25 mg daily ) . 4 . 43 patients ( 68.2 % ) completed the study . There were no drop-outs due to side-effects . Total Montgomery and Asberg Depression Rating Scale scores were significantly decreased ( p < 0.01 ) on day 14 , with a response rate of 76.7 % . 5 . Improvements were also observed in anxiety and cognitive performance . Side-effects were seen in only 11.7 % of patients , with no changes in laboratory or ancillary safety parameters . Tianeptine is thus effective and well tolerated in this category of patient OBJECTIVE Cognitive remediation is an efficacious treatment for schizophrenia and , when used within broader psychosocial treatments , improves transfer to real-world behavior change . The authors examined whether cognitive remediation effectively generalizes to functional competence and real-world functioning as a st and alone treatment and when combined with a functional skills treatment . METHOD Out patients with schizophrenia ( N=107 ) were r and omly assigned to receive cognitive remediation , functional adaptation skills training , or combined treatment , with cognitive remediation preceding functional skills training .  Clinical symptoms , neurocognition , social competence , functional competence , and case-manager-rated real-world behavior were assessed at baseline , at end of treatment , and at a 12-week durability assessment . RESULTS Neurocognition improved , with durable effects , after cognitive remediation but not after functional skills training . Social competence improved both with functional skills training and with combined treatment but not with cognitive remediation alone . Improvements in functional competence were greater and more durable with combined treatment . Cognitive remediation alone did not produce significant improvements in real-world behavior , but when combined with functional skills training , statistically significant improvements from baseline to end of treatment and follow-up were observed in community or household activities and work skills . Number-needed-to-treat analyses suggest that as few as three cases are required for treatment to induce a meaningful improvement in functional skills . CONCLUSIONS In a short intervention , cognitive remediation produced robust improvements in neurocognition . Generalization to functional competence and real-world behavior was more likely when supplemental skills training and cognitive remediation were combined OBJECTIVE Depression in older adults is often associated with cognitive abnormalities and may predict later development of a primary cognitive disorder . This double-blind , r and omized , placebo-controlled pilot study was design ed to assess the safety and efficacy of galantamine augmentation of antidepressant treatment for depressive and cognitive symptoms in older adults with major depression . METHODS Thirty-eight , non-demented older adults ( age > 50 ) with major depression were r and omized to receive galantamine or placebo augmentation of st and ard antidepressant pharmacotherapy ( venlafaxine XR or citalopram ) .  Mood and cognitive status were monitored for 24 weeks using the 24-item Hamilton Rating Scale for Depression and the Repeatable Battery for the Assessment of Neuropsychological Status . RESULTS Both groups showed significant improvements in mood and cognition over 24 weeks , but no significant difference was found in change over time between groups . An exploratory post-hoc analysis suggested that patients r and omized to galantamine had lower depression scores compared to patients in the placebo group after 2 weeks of treatment . Dropout was high with more subjects r and omized to antidepressant plus galantamine  withdrawing early from the study . CONCLUSIONS This pilot study failed to demonstrate a benefit for galantamine augmentation of antidepressant medication in the treatment of depression in older adults . Future studies should explore strategies for reducing dropout in such longitudinal trials and more carefully assess time to response with cholinesterase inhibitor augmentation OBJECTIVE Knowledge of the relationship between various clinical characteristics and cognitive functioning is advancing , but little is known about the cognitive response to treatment for geriatric depression . The purpose of this study was to examine the cognitive response to treatment for patients with late-life depression . METHOD Subjects included 45 nondemented , elderly depressed patients who achieved remission after 12 weeks of antidepressant treatment and 20 elderly comparison subjects .  All subjects were administered a battery of clinical measures , including cognitive screening instruments , before and after treatment . RESULTS As a group , the elderly depressed patients showed a small improvement in overall cognitive functioning after treatment . Among depressed patients with concomitant cognitive impairment at baseline , performance on the Mattis Dementia Rating Scale domains of conceptualization and initiation/perseveration improved significantly relative to those of depressed patients with normal cognition . Despite the improvement following treatment , the overall level of cognitive functioning in the elderly depressed patients with cognitive impairment at baseline remained mildly impaired , especially in the memory and initiation/perseveration domains . CONCLUSIONS Elderly depressed patients with cognitive impairment may experience improvement in specific domains following antidepressant treatment but may not necessarily reach normal levels of performance , particularly in memory and executive functions . This subgroup of late-life depression patients is likely at high risk of developing progressive dementia OBJECTIVE This study compared the effects of duloxetine , 60 mg/day , versus placebo on cognition , depression , and pain in elderly patients with recurrent major depressive disorder . METHOD Patients were r and omly assigned ( 2:1 ) to duloxetine , 60 mg/day ( N=207 ) , or placebo  ( N=104 ) for 8 weeks in a double-blind study . The primary outcome measure was a prespecified composite cognitive score composed of four individual tests . Secondary measures included the Geriatric Depression Scale , the Hamilton Depression Rating Scale , the Visual Analogue Scale assessing pain , and st and ard safety and tolerability assessment s. RESULTS Patients had a median age of 72 years ( range=65 - 90 ) .  Duloxetine demonstrated significantly greater improvement in the composite cognitive score versus placebo ( least-squares mean change from baseline to endpoint : 1.95 versus 0.76 ) , driven by improved verbal learning and memory . Duloxetine treatment showed significantly greater baseline-to-endpoint reductions in both Hamilton depression scale ( -6.49 versus -3.72 ) and Geriatric Depression Scale ( -4.07 versus -1.34 ) total scores compared with placebo . Hamilton depression scale response ( 37.3 % versus 18.6 % ) and remission ( 27.4 % versus 14.7 % ) rates at endpoint were significantly higher for duloxetine than for placebo . Duloxetine significantly improved Visual Analogue Scale scores for back pain and time in pain while awake versus placebo . Significantly fewer patients receiving duloxetine withdrew from the study because of lack of efficacy ( 2.9 % versus 9.6 % ) ; the incidences of discontinuation due to adverse events were similar for duloxetine and placebo ( 9.7 % versus 8.7 % ) . CONCLUSIONS Duloxetine improved cognition , depression , and some pain measures and was safe and well tolerated in elderly patients with recurrent major depressive disorder OBJECTIVE This study was design ed to evaluate the comparative efficacy and safety of sertraline and nortriptyline for the treatment of major depressive disorder in older adults . METHOD A double-blind , parallel group design was used to compare 210 out patients , 60 years of age and older , who met DSM-III-R criteria for major depressive episode and had a minimum Hamilton Depression Rating Scale score of 18 . The patients were r and omly assigned to 12 weeks of treatment with either sertraline ( 50 - 150 mg/day ) or nortriptyline ( 25 - 100 mg/day ) . RESULTS The safety profiles of the two treatments were similar except that nortriptyline treatment was associated with a significant increase in pulse rate , whereas sertraline was associated with a nonsignificant decrease . Efficacy of both drugs was similar for both treatments at all time points , with 71.6 % ( N=53 of 74 ) of the sertraline-treated patients and 61.4 % ( N=43 of 70 ) of the nortriptyline-treated patients achieving responder status by week 12 . Time to response was also similar , with more than 75 % of the improvement in scores on the Hamilton depression scale having occurred by week 6 . Secondary efficacy measures ( posttreatment measures of cognitive function , memory , and quality of life ) revealed a significant advantage for sertraline treatment . CONCLUSIONS Primary efficacy measures showed sertraline and nortriptyline to be similarly effective . With secondary outcome measures there was consistent evidence of an advantage for the sertraline-treated group . The clinical impact of these measures on the long-term well-being of elderly depressed patients should be examined in a study of maintenance treatment BACKGROUND Maternal depression is associated with abnormal processing of infant distress . This may explain why depression disrupts maternal behaviour and ultimately child outcomes . Underst and ing and improving such processing , in depressed mothers as early as possible is thus important . AIM The focus of the current study was to investigate whether Cognitive Behavioural Therapy ( CBT ) normalises depressed pregnant women 's  abnormal attentional processing of infant distress . METHOD Depressed pregnant women participating in a r and omised control trial completed a measure of attentional bias for infant distress before and after intervention . Women received either CBT ( n=12 ) or usual care [ UC ] ( n=12 ) between their first and last trimesters of pregnancy . RESULTS At baseline , depressed women in both arms showed a diminished attentional bias for infant distress compared to a non-depressed comparison group ( n=51 ) . Following intervention attentional biases of women who received CBT increased becoming comparable to non-depressed women . In contrast there was no improvement in the UC arm . CONCLUSIONS If replicated , the findings may suggest that CBT during pregnancy improves mother 's basic processing of infant stimuli before their child is born . LIMITATIONS The sample size was relatively small and there was some loss to follow up between the pre and post intervention sessions Objective : To determine whether augmenting work therapy ( WT ) with neurocognitive enhancement therapy ( NET ) yields greater improvement in working memory performance than WT alone and whether there is an interaction with severity of impairment The efficacy and tolerability of Lu AA21004 at 5 mg/day , a novel multimodal antidepressant , were assessed in elderly patients with recurrent major depressive disorder . Patients were r and omly assigned ( 1 : 1 : 1 ) to Lu AA21004 5 mg/day , duloxetine 60 mg/day ( reference ) or to placebo in an 8-week double-blind study . The primary efficacy measure was the 24-item Hamilton Depression Scale ( HAM-D24 ) total score ( analysis of covariance , last observation carried forward ) . Patients ( mean age 70.6 years ) had a mean baseline HAM-D24 score of 29.0 .  Lu AA21004 showed significantly ( P=0.0011 ) greater improvement on the primary efficacy endpoint compared with placebo at week 8 ( 3.3 points ) . Duloxetine also showed superiority to placebo at week 8 , thereby validating the study . HAM-D24 response ( 53.2 vs. 35.2 % ) and HAM-D17 remission ( 29.2 vs. 19.3 % ) rates at endpoint were higher for Lu AA21004 than for placebo . Lu AA21004 showed superiority to placebo in cognition tests of speed of processing , verbal learning and memory . The withdrawal rate due to adverse events was 5.8 % ( Lu AA21004 ) , 9.9 % ( duloxetine ) and 2.8 % ( placebo ) . Whereas nausea was the only adverse event with a significantly higher incidence on treatment with Lu AA21004 ( 21.8 % ) compared with placebo ( 8.3 % ) , the incidence of nausea , constipation , dry mouth , hyperhidrosis and somnolence was higher for duloxetine . In conclusion , Lu AA21004 was efficacious and well tolerated in the treatment of elderly patients with recurrent major depressive disorder OBJECTIVE To assess combined antidepressant and cognitive enhancer treatment in elderly patients presenting with depression plus cognitive impairment . METHODS Twenty-three elderly ( > 50 years old ) depressed , cognitively impaired ( DEP-CI ) patients participated in a pilot study . We evaluated whether , after 8 weeks of open antidepressant treatment , donepezil HCl ( Aricept ) would afford added cognitive benefit compared to placebo in a r and omized 12-week trial . A sub sample continued in an 8-month extension phase of open treatment with donepezil . Neuropsychological testing ( NPT ) was performed and  antidepressant response monitored at baseline and the 8 , 20 , and 52-week time points . RESULTS At 8-weeks , the  antidepressant response rate was 61 % ( 14/23 ) . Improvement in SRT immediate recall ( SRT-IR ; e.g. episodic verbal memory ) was observed in responders compared to non-responders . During the 12-week , placebo-controlled , donepezil add-on trial , patients on donepezil showed further improvement in SRT-IR versus patients on placebo . In the open extension phase , patients who continued open donepezil treatment ( n = 6 ) maintained improvement in memory and tended to show an advantage over patients who never received donepezil and were evaluated at the 52-week time point ( n = 6 ) . There were no observed significant donepezil effects on non-memory cognitive domains . CONCLUSION These preliminary findings suggest that addition of a cholinesterase inhibitor ( AChEI ) following antidepressant medication treatment in elderly Dep-CI patients may improve cognition , and support the need for a confirmatory , larger r and omized placebo-controlled trial BACKGROUND Neuropsychological deficits in depression include difficulties with psychomotor speed , executive functions and memory . Some of these changes persist despite antidepressant treatment . While research in other areas of psychiatry has shown cognitive training techniques to be effective , only one study has evaluated this approach in depression . METHODS Sixteen patients ( mean age=33.5years ) with a lifetime diagnosis of major depressive disorder were administered a st and ardised battery of neuropsychological tests and allocated to treatment ( n=8 ) or waitlist control ( n=8 ) conditions . The treatment consisted of 10-weeks of twice weekly cognitive training using the Neuropsychological Educational Approach to Remediation . All participants were re-assessed after 10-weeks by interviewers blinded to group allocation . RESULTS Participants in the treatment condition demonstrated greater improvements on tests of memory encoding and memory retention than the waitlist control group . There were no observable benefits in terms of psychomotor speed or executive functions or in self-reported levels of disability . Affective symptoms also remained stable . LIMITATIONS This study included a small sample of participants and treatment allocation was not r and omised . CONCLUSIONS Cognitive training in affective disorders improves memory performance . It may be an effective non-pharmacological treatment option for improving cognitive functions , which in turn , may improve psychosocial functioning and reduce disability . This study supports theories suggesting cognitive training may promote neuroplasticity BACKGROUND Cognitive behavioral therapy ( CBT ) is an effective treatment for emotional disorders such as anxiety or depression , but the mechanisms underlying successful intervention are far from understood . Although it has been a long-held view that psychopharmacological approaches work by directly targeting automatic emotional information processing in the brain , it is usually postulated that psychological treatments affect these processes only over time , through changes in more conscious thought cycles . This study explored the role of early changes in emotional information processing in CBT action . METHODS Twenty-eight untreated patients with panic disorder were r and omized to a single session of exposure-based CBT or waiting group .  Emotional information processing was measured on the day after intervention with an attentional visual probe task , and clinical symptoms were assessed on the day after intervention and at 4-week follow-up . RESULTS Vigilance for threat information was decreased in the treated group , compared with the waiting group , the day after intervention , before reductions in clinical symptoms . The magnitude of this early effect on threat vigilance predicted therapeutic response after 4 weeks . CONCLUSIONS Cognitive behavioral therapy rapidly affects automatic processing , and these early effects are predictive of later therapeutic change . Such results suggest very fast action on automatic processes mediating threat sensitivity , and they provide an early marker of treatment response . Furthermore , these findings challenge the notion that psychological treatments work directly on conscious thought processes before automatic information processing and imply a greater similarity between early effects of pharmacological and psychological treatments for anxiety than previously thought OBJECTIVES The present study was design ed to evaluate the effect of twelve weekly sessions of the cognitive-behavioral program originally known as the Integriertes Psychologisches Therapieprogramm für Schizophrene Patienten , design ated the Integrated Psychological Therapy ( IPT ) program in English , on cognition , social adjustment and quality of life in schizophrenic out patients , comparing it to the effect of treating such patients as usual . METHOD Fifty-six adult out patients ( from 18 to 65 years of age ) with ICD-10-based diagnoses of schizophrenia were r and omly assigned to two different groups : active intervention ( IPT group ) ; and treatment as usual ( control group ) . Outcome measures were quality of life ( as determined using the WHOQOL-Bref ) , cognition ( Mini-Mental State Examination and Word Recall Test ) , global functioning ( DSM-IV Global Assessment of Functioning Scale ) , social functioning ( Social and Occupational Functioning Assessment Scale ) and social adjustment ( Social Adjustment Scale ) . RESULTS The findings suggest that , in comparison with treatment as usual ( control group ) , the twelve-session IPT program had a positive effect on several outcome measures : cognition in the domains of spatiotemporal orientation ( p = 0.051 ) and memory ( p = 0.031 ) ; overall social adjustment ( p = 0.037 ) , leisure/social life ( p = 0.051 ) and family relations ( p = 0.008 ) ; overall functioning ( p = 0.000 ) ; social-occupational functioning ( p = 0.000 ) ; and quality of life in the psychological domain ( p = 0.021 ) . CONCLUSIONS The twelve-session cognitive-behavioral IPT intervention demonstrated superiority over treatment as usual in its effects on cognition , social adjustment and quality of life . Studies involving larger sample s , longer follow-up periods and additional outcome measures are needed in order to assess the specific effects on dimensions of social functioning , cognitive functioning and quality of life in patients with schizophrenia OBJECTIVE Return of functional ability is a central goal in the treatment of major depressive disorder . We conducted two trials with the same protocol that was design ed to assess functioning after 8 Weeks of treatment with duloxetine . METHODS The a priori primary outcome was improvement in the Hamilton Depression Rating Scale ( HAMD ) item 7 ( work/activities ) . Secondary outcomes included improvement in depressive symptoms assessed by the HAMD Maier subscale , and improvement in functioning assessed by the Sheehan Disability Scale ( SDS ) , and the Social Adaptation Self-evaluation Scale ( SASS ) .  Patients were r and omly assigned to duloxetine 60 mg/day ( Trial I , n = 257 ; Trial II , n = 261 ) or placebo ( Trial I , n = 127 ; Trial II , n = 131 ) . Changes from baseline were analyzed using a mixed-effects model repeated measures approach . RESULTS At Week 8 , duloxetine was superior to placebo in improving HAMD work/activities ( p < 0.001 ) in Trial II , but not Trial I ( p = 0.051 ) , and Maier scores ( p < 0.01 ) in both trials . At Week 12 , duloxetine was superior to placebo on improving SASS scores in both trials , and the SDS in Trial II . CONCLUSION Treatment with duloxetine was associated with significant improvement in depressive symptoms compared with placebo , but improvement in HAMD work/activities was inconsistent at 8 weeks BACKGROUND Major depressive disorder ( MDD ) is often accompanied by significant cognitive impairment , and there are limited interventions specific to this particular symptom . S-adenosyl methionine ( SAMe ) , a naturally occurring molecule which serves as a major methyl-donor in human cellular metabolism , is required for the synthesis and maintenance of several neurotransmitters that have been implicated in the pathophysiology and treatment of cognitive dysfunction in MDD . METHODS This study is a secondary analysis of a clinical trial involving the use of adjunctive SAMe for MDD . Forty-six serotonin-reuptake inhibitor ( SRI ) non-responders with MDD enrolled in a 6-week , double-blind , r and omized trial of adjunctive oral SAMe  were administered the self-rated cognitive and physical symptoms question naire ( CPFQ ) , a vali date d measure of cognitive as well as physical symptoms of MDD , before and after treatment . RESULTS There was a greater improvement in the ability to recall information ( p=0.04 ) and a trend toward statistical significance for greater improvement in word-finding ( p=0.09 ) for patients who received adjunctive SAMe than placebo . None of the remaining five items reached statistical significance . CONCLUSION These preliminary data suggest that SAMe can improve memory-related cognitive symptoms in depressed patients , and warrant replication BACKGROUND Cognitive deficits have been described in patients with major depression ( MD ) , although many aspects remain unsettled . METHOD During an episode of MD and after remission we used tasks exploring attention , implicit , antero grade and retro grade memory to investigate 48 drug-free patients aged over 50 years without dementia , comparing them with 15 normal volunteer controls ( NC ) . We also evaluated the effect of antidepressant therapy ( ADT ) with fluoxetine ( F ) or reboxetine ( R ) at baseline ( T0 ) and six months later ( T6 ) . RESULTS 42 patients completed the study and 6 dropped out ; 33 patients were considered " Remitters " ( RP ) ( 17 F pts and 16 R pts ) . At T0 , the entire group of MD patients ( MDP ) had worse performances than NC in Mini Mental Status Examination ( MMSE ) , Wechsler Memory Scale ( WMS ) total score ( TS ) , in a few subtests of WMS and in autobiographical memory . RP at T0 had the same impaired tasks and at T6 had significantly improved in MMSE , WMS . TS and many memory tests but they still differed from NC in a few complex tasks requiring more cognitive effort . LIMITATIONS The effects and differences between F and R must be viewed with caution considering the relatively small sample ; only attention and memory were investigated . CONCLUSIONS Our findings confirm a negative effect of depression on memory with a significant but incomplete improvement after remission and without differences between F and R. We speculate that both a " state " and a " trait " depressive component underlie this memory impairment
target: Results show that various classes of antidepressants exert improving effects on cognitive function across several cognitive domains .
  Specifically , studies suggest that SSRIs , the SSRE tianeptine , the SNRI duloxetine , vortioxetine and other antidepressants such as bupropion and moclobemide may exert certain improving effects on cognitive function in depression , such as in learning and memory and executive function .
  The few non-pharmacological studies conducted employing cognitive orientated treatments and cognitive remediation therapy show promising results for the improvement of cognitive impairment in depression .
background: Cognitive dysfunction is of clinical significance and exerts longst and ing implication on patients ׳ function .
  Pharmacological and non-pharmacological treatments of cognitive dysfunction are emerging .
  This review evaluates pharmacological and non-pharmacological treatments of cognitive impairment primarily in the domains of memory , attention , processing speed and executive function in clinical depression .