The Comparative Efficacy of Antidepressant and Psychological Therapies on Cognition in Depression: A Systematic Review and Network Meta-Analysis.

A common hallmark of Major Depressive Disorder (MDD) is deficits in cognitive functions during an episode and in remission. These cognitive deficits interfere with daily living and are significant predictors of MDD relapse. To address the role cognitive functioning plays in MDD, we aimed to conduct a systematic review and network meta-analysis of randomized controlled trials to estimate the comparative efficacy of psychological and pharmacological depression treatments on objective cognitive functioning. We conducted a systematic literature search in MEDLINE, Embase, PsycINFO, and Scopus. The review included commonly prescribed psychological and pharmacological therapies for depression, and our primary outcome was a pre-post change in cognition. We conducted a random-effects frequentist network meta-analysis to estimate the relative efficacy of included treatments. The review included 40 randomized trials, with 32 studies evaluating antidepressants, six psychotherapies and two, a combination of psychotherapies and antidepressants. Vortioxetine was the only antidepressant showing a small significant effect compared with placebo on the Digit Symbol Substitution Test, Trial Making Test Part B, Stroop test, Congruent condition and word list learning tests (g = -0.23 to -0.29). Common antidepressants, including escitalopram, citalopram, paroxetine and fluoxetine were not significantly different from placebo in improving cognition. The preliminary findings from psychotherapies indicate that cognitive behavioral therapy might improve recognition memory but not spontaneous recall. The findings suggest that, among antidepressants, vortioxetine is the sole treatment improving cognition in depression. The effects were however small, highlighting the need for the development of MDD interventions targeting cognition.