Cognitive remediation for people with depression

by Gabriele Nibbio MD, PhD, Post-Doctoral Fellow, Department of Clinical and Experimental Sciences, University of Brescia

Cognitive Remediation (CR) is a well-established treatment for people with psychosis: it is currently recommended in international guidelines for the treatment of schizophrenia based on scientific evidence attesting its positive effects on cognitive performance and psychosocial functioning.

However, while the usefulness of CR for people with schizophrenia is well recognized, fewer clinical studies have investigated whether CR can also be effective in improving the lives of people with depression. In fact, cognitive symptoms can be a frequent issue during depressive episodes, and some cognitive impairment often persists when the affective symptoms are resolved.

A recent study aimed to assess whether Computerized CR, delivered by a trained therapist using the Cogpack program (Marker Software®, Mannheim, Germany), could provide significant benefits for people diagnosed with Major Depressive Disorder. The study was conducted in Italy and included nine different centers, recruiting participant via university clinics and hospitals. Of the 101 participants, 52 were randomized to receive the computerized CR intervention and 49 were randomized to a control condition, i.e. playing computer games such as “Minesweeper,” “Solitaire” and “Pinball”.

Both the CR program and the control condition were delivered twice a week in 45-min sessions for 12 weeks. Participants allocated to the control condition were invited to receive the CR intervention at the end of the study.

CR showed significantly larger improvements in subjective and clinician-rated depressive symptoms and in global clinical severity. They also showed larger improvements in cognitive performance and a greater reduction in subjective cognitive impairment. All these findings indicate CR can offer substantial benefits to people with depression, both in terms of depression symptoms and cognitive performance.

The improvement observed in depressive symptoms, in particular, represents an interesting finding: it could be hypothesized that the cognitive stimulation provided by CR leads to an increase in neural activation and metabolism and, therefore, an increased release of neurotrophic factors, which have well-recognized antidepressant properties.

Given these benefits, offering CR in a more widespread and consistent manner should increasingly become an objective for mental health services.

The full version of this multicentre randomized clinical trial is available to read and download for free at: https://www.cambridge.org/core/journals/european-psychiatry/article/effectiveness-of-cognitive-remediation-in-subjects-with-major-depressive-disorder-a-multicenter-randomized-controlled-study-in-a-realworld-setting/E91D53F51EBA336359144A95206668C5

---

If you or your team are interested in joining the growing global community of Cognitive Remediation therapists and completing our online course, visit our Training page to find out more or Get in touch to book your place today.