The cognitive neuropsychological model of depression

Abstract

Major Depressive Disorder (MDD) is associated with a number of significant impairments in social, occupational and educational functioning. Generalized cognitive disturbances have recently been acknowledged as an important aspect for both diagnosis and prognosis of MDD [1] , in which greater cognitive deficits have been associated with poorer psychosocial outcomes in depressed people. Unfortunately, no so many available antidepressant drugs target cognitive symptoms nor have been either approved for mitigating them. In the absence of studies using random assignment to medication conditions–there are very few RCT with neurocognitive tests as primary outcome measure–, non-pharmacological and non-invasive treatment for cognitive symptoms is gaining momentum so as to improve treatment responses, to decrease relapse rates and even to achieve global remission (i.e., beyond clinical remission and including amelioration of psychosocial difficulties). In this regard, cognitive rehabilitation and cognitive training programs have been tested with controversial results. Compelling evidence has identified several types of disrupted cognition in depression from high-level psychological constructs (attributional style or negative schemata) to basic cognitive processes (such as memory, executive functioning or processing speed), driving to the current cognitive and neuropsychological model of depression. Theoretical accounts of depression propose that basic cognitive processes play a causal role in the development of both high-level psychological constructs and symptoms [2] , and this may account for the modest effects of antidepressant treatments. Understanding how these processes are functionally organized in the depressed brain should help in establishing new targets for brain stimulation to facilitate the effects of tailored cognitive rehabilitation. In light of this imperative need to develop specific treatments for cognitive symptoms, a comprehensive rehabilitation program for MDD based on the cognitive neuropsychological model of depression will be presented along with preliminary findings.