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https://www.cnsvs.co...id=43&Itemid=60
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COMPARATIVE NEUROCOGNITIVE PERFORMANCE OF PATIENTS ON ANTIDEPRESSANTS
C Thomas Gualtieri MD Lynda G Johnson, PhD Kenneth B Benedicts, PhD
Ms Submitted for publication, November, 2004
ABSTRACT: Patients with depression have neuropsychological deficits in attention, memory, psychomotor speed, processing speed and executive function. When they are treated with effectively, their deficits tend to improve, but they do not normalize.
Is this a function of the relative neurocognitive effects of the various antidepressants? The clinical literature is meager on this question. METHOD: This report describes a naturalistic, cross-sectional study of 264 patients with major depression who were treated effectively with any one of eight modern antidepressants. A computerized neurocognitive screening battery was employed to measure neurocognitive performance. RESULTS: The neurocognitive performance of depressed patients on different antidepressants was significantly different. There were clear indications of a superior effect on neurocognition among patients on bupropion, in the domains of memory, reaction time and cognitive flexibility. Patients on venlafaxine and the SSRI’s (escitalopram, fluoxetine, paroxetine, citalopram,and sertraline) performed less well, but did not differ among themselves. CONCLUSIONS: In the clinic setting, computerized testing demonstrates small but significant differences in neurocognitive performance. The noradrenergic/dopaminergic antidepressant, bupropion is clearly superior to other modern antidepressants. The importance of these differences remains to be demonstrated; they may be less important in the face of differences in efficacy and side effect profiles in individual patients. It is arguable, however, that consideration of the neurocognitive effects of antidepressants could improve clinical outcome and reduce long term morbidity associated with treatment.
C Thomas Gualtieri MD Lynda G Johnson, PhD Kenneth B Benedicts, PhD
Ms Submitted for publication, November, 2004
ABSTRACT: Patients with depression have neuropsychological deficits in attention, memory, psychomotor speed, processing speed and executive function. When they are treated with effectively, their deficits tend to improve, but they do not normalize.
Is this a function of the relative neurocognitive effects of the various antidepressants? The clinical literature is meager on this question. METHOD: This report describes a naturalistic, cross-sectional study of 264 patients with major depression who were treated effectively with any one of eight modern antidepressants. A computerized neurocognitive screening battery was employed to measure neurocognitive performance. RESULTS: The neurocognitive performance of depressed patients on different antidepressants was significantly different. There were clear indications of a superior effect on neurocognition among patients on bupropion, in the domains of memory, reaction time and cognitive flexibility. Patients on venlafaxine and the SSRI’s (escitalopram, fluoxetine, paroxetine, citalopram,and sertraline) performed less well, but did not differ among themselves. CONCLUSIONS: In the clinic setting, computerized testing demonstrates small but significant differences in neurocognitive performance. The noradrenergic/dopaminergic antidepressant, bupropion is clearly superior to other modern antidepressants. The importance of these differences remains to be demonstrated; they may be less important in the face of differences in efficacy and side effect profiles in individual patients. It is arguable, however, that consideration of the neurocognitive effects of antidepressants could improve clinical outcome and reduce long term morbidity associated with treatment.
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