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Depression

Do thinking problems in first-time depression outlast the low mood?

Schmid M, Hammar A · Frontiers in psychology · 2013

Open access · cc by · source: Europe PMC

A year after their first depressive episode, most patients had largely recovered from their symptoms but still did worse than matched controls at suppressing automatic responses and at naming words from a category.

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Study at a glance

Design
Case-control — Longitudinal patient-versus-matched-control comparison: executive-function tests in the acute phase and again at a 1-year follow-up, with patients split by relapse history
N
N=56 · 28 first-episode MDD patients and 28 individually matched healthy controls; patient subgroups (relapse, no relapse, no change) are much smaller
Population
Young adult outpatients with a first episode of major depressive disorder and matched healthy controls in Bergen, Norway
Outcome
D-KEFS Color-Word Interference (inhibition, inhibition/switching), Verbal Fluency (phonemic, semantic, switching) and Trail Making scores; relapse within 1 year

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Key findings

Depression severity (MADRS) fell sharply, from an average of about 24.68 at the first test to 9.96 at follow-up, so most patients were in remission. Even so, the patient group remained worse than controls at inhibition, especially the harder inhibition/switching condition, and at semantic (category) fluency, while phonemic fluency and general mental flexibility did not differ. Patients who relapsed had performed worst on inhibition/switching in the acute phase, and in a logistic regression this score was the only significant predictor of relapse (odds ratio 1.146; the model classified 64.3% of patients correctly). Semantic fluency did not predict relapse.

Methodology

The researchers re-tested 28 people who had been diagnosed with a first episode of major depression about a year earlier, along with 28 healthy controls matched to them individually. Everyone completed three executive-function tests from the D-KEFS battery: a Stroop-style color-word interference test, a verbal fluency test and a trail-making test. Patients were also grouped by whether they had experienced a relapse during the year, and the team tested whether poor inhibition in the acute phase predicted relapse.

Limitations

The relapse analysis rests on very small subgroups, and the authors say the low numbers may leave the study underpowered, so the relapse link is a lead to replicate rather than an established predictor. Relapse was identified from interviews without a structured diagnostic interview at follow-up, so comorbid conditions may have been missed. Eleven patients were on antidepressants at follow-up, and medication users differed on some tests, which muddies interpretation. The sample was young outpatients with little comorbidity, so the results may not generalize to older, hospitalized or more complex patients.

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