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Differential impact of affective and cognitive symptoms on remission of major depression.
The Lancet Psychiatry ( IF 30.8 ) Pub Date : 2019-12-01 , DOI: 10.1016/s2215-0366(19)30384-0
Stefan M Gold 1 , Christian Otte 2
Affiliation  

With great interest we read the meta-analysis by Maria Semkovska and colleagues on cognitive dysfunction in patients remitted from an episode of major depressive disorder. This Article tackles an important clinical issue as deficits in cognitive function might contribute to the long-term burden of the disorder. We agree that potential neurobiological underpinnings of this effect are of interest. However, we would like to point out that the results obtained could, at least in part, be explained by the way remission is being defined. Most included studies used a standard definition for remission—patients no longer meeting diagnostic criteria for major depressive disorder and their depression severity score falling below an established threshold. Given that the presence of the core symptoms (depressive mood and anhedonia) is required for a diagnosis of the disorder, remission also requires these symptoms to subside. However, this requirement does not apply to other symptoms of major depressive disorder, such as cognitive problems. Thus, by definition, patients in a remitted state will have responded with regard to affective symptomatology, but not necessarily cognitive symptoms. Notably, a patient-level meta-analysis has shown that items related to depressed mood and anhedonia showed the largest improvements after pharmacotherapy and cognitive behavioural therapy.

中文翻译:

情感和认知症状对重度抑郁症缓解的不同影响。

我们非常感兴趣地阅读了玛丽亚·塞姆科夫斯卡(Maria Semkovska)及其同事关于因重度抑郁症发作而缓解的患者认知功能障碍的荟萃分析。这篇文章解决了一个重要的临床问题,因为认知功能缺陷可能会导致疾病的长期负担。我们同意这种作用的潜在神经生物学基础是令人感兴趣的。但是,我们想指出的是,至少可以通过定义缓解的方式来解释所获得的结果。大多数纳入研究使用了缓解的标准定义-患者不再符合主要抑郁症的诊断标准,并且其抑郁严重程度得分降至既定阈值以下。考虑到诊断该疾病需要核心症状(情绪低落和快感不足),缓解也需要这些症状消退。但是,此要求不适用于重度抑郁症的其他症状,例如认知问题。因此,根据定义,处于缓解状态的患者在情感症状方面会有所反应,但不一定是认知症状。值得注意的是,患者水平的荟萃分析显示,与情绪低落和快感不足相关的项目在药物治疗和认知行为治疗之后显示出最大的改善。处于缓解状态的患者在情感症状方面会有所反应,但不一定是认知症状。值得注意的是,患者水平的荟萃分析表明,与情绪低落和快感不足相关的项目在药物治疗和认知行为疗法之后显示出最大的改善。处于缓解状态的患者在情感症状方面会有所反应,但不一定是认知症状。值得注意的是,患者水平的荟萃分析表明,与情绪低落和快感不足相关的项目在药物治疗和认知行为疗法之后显示出最大的改善。
更新日期:2019-11-22
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