Major Depressive Disorder (MDD) remains a leading cause of disability worldwide, with substantial effects on quality of life and psychosocial functioning. While antidepressant medications play a pivotal role in managing the affective symptoms of MDD, cognitive disturbances—such as difficulties in memory, attention, and executive functioning—often persist and contribute to functional impairment. In addressing this gap, a recent study proposes an innovative approach to enhance cognitive rehabilitation for patients with MDD. This article delves into the clinical trial that seeks to evaluate the effectiveness of INtegral Cognitive REMediation (INCREM) in alleviating cognitive difficulties and improving patient outcomes.
Unveiling INCREM: Bridging Functional and Cognitive Recovery in MDD
The clinical trial, designed by a collaborative team across multiple institutions in Barcelona, Spain, including Vicent-Gil Muriel M., Beatriz Raventós, and Maria J. Portella, introduces an intervention combining Functional Remediation (FR) with Computerized Cognitive Training (CCT). The research, published in BMC Psychiatry [DOI: 10.1186/s12888-019-2117-4], outlines the rationale and methodology for INCREM, an integrated treatment that addresses cognitive deficits while promoting better psychosocial functioning in patients with MDD.
The Clinical Trial: A Synopsis of the Methodology
The randomized clinical trial, registered under Clinical Trials NCT03624621, enrolled 81 patients diagnosed with MDD, either in clinical remission or partial remission. Participants were randomly allocated to one of three groups:
1. INCREM, encompassing both FR and CCT;
2. Psychoeducation combined with online games as an active control;
3. Treatment As Usual (TAU), representing the standard care without additional cognitive interventions.
Over 12 weeks, participants in the INCREM group engaged in 12 group sessions of approximately 110 minutes each, focusing on strategies to improve cognitive performance and daily functioning. The primary outcome measure was the percentage of change in psychosocial functioning post-treatment, determined using the Functional Assessment Short Test (FAST). Secondary practical outcomes included the number of sick leaves and changes in daily activities.
Significance and Innovation in MDD Treatment
This clinical trial holds the potential to reshape the treatment paradigm for cognitive symptoms in MDD. By employing a multifaceted approach to cognitive remediation, the study seeks to extend the benefits of conventional therapies beyond the management of mood symptoms, aiming to enhance overall quality of life and functioning.
The Expected Outcomes: More than Cognitive Gains
While the primary focus is on cognitive improvements, the researchers are also interested in how these changes translate into real-life benefits. An increase in the psychosocial functioning of participants, as measured by FAST, would indicate progress toward a comprehensive treatment model that addresses the global impact of MDD on patients’ lives.
Implications for Future Research and Practice
Should INCREM prove successful, it could set a precedent for combining cognitive-specific interventions with functional strategies in the management of MDD. This innovative treatment could fill a crucial void in current therapeutic approaches, serving as a template for future research and clinical practice advancements.
References
1. Vicent-Gil, M., Raventós, B., Marín-Martínez, E. D., González-Simarro, S., Martínez-Arán, A., Bonnin, C. D. M., … & Portella, M. J. (2019). Testing the efficacy of INtegral Cognitive REMediation (INCREM) in major depressive disorder: Study protocol for a randomized clinical trial. BMC Psychiatry, 19(1), 135. DOI: 10.1186/s12888-019-2117-4.
2. McIntyre, R. S., Cha, D. S., Soczynska, J. K., Woldeyohannes, H. O., Gallaugher, L. A., Kudlow, P., et al. (2013). Cognitive deficits and functional outcomes in major depressive disorder: Determinants, substrates, and treatment interventions. Depression and Anxiety, 30(6), 515-527. DOI: 10.1002/da.22063.
3. Jaeger, J., Berns, S., Uzelac, S., & Davis-Conway, S. (2006). Neurocognitive deficits and disability in major depressive disorder. Psychiatry Research, 145(1), 39-48. DOI: 10.1016/j.psychres.2005.11.011.
4. Motter, J. N., Pimontel, M. A., Rindskopf, D., Devanand, D. P., Doraiswamy, P. M., & Sneed, J. R. (2016). Computerized cognitive training and functional recovery in major depressive disorder: A meta-analysis. Journal of Affective Disorders, 189, 184-191. DOI: 10.1016/j.jad.2015.09.022.
5. Torrent, C., Del Mar Bonnin, C., Martínez-Arán, A., Valle, J., Amann, B. L., González-Pinto, A., et al. (2013). Efficacy of functional remediation in bipolar disorder: A multicenter randomized controlled study. The American Journal of Psychiatry, 170(8), 852-859. DOI: 10.1176/appi.ajp.2012.12070971.
Keywords
1. INtegral Cognitive Remediation (INCREM)
2. Major Depressive Disorder Cognitive Treatment
3. Cognitive Remediation Efficacy MDD
4. Functional Remediation CCT Combination
5. MDD Psychosocial Functioning Improvement
Conclusion
As the global healthcare community continues to grapple with the complex challenges of MDD, INCREM represents a promising advance that could revolutionize the approach to treating cognitive disruptions associated with depression. This trial ushers in a hopeful horizon, potentially heralding a new era where a combination of innovative cognitive and functional remediations could emerge as cornerstones in MDD treatment. As the research unfolds, the significance of such interventions in enhancing the lives of those affected by MDD will be closely watched by clinicians and patients alike.