Rethinking Depression

Depression may be
more difficult to
decipher than expected

Fully understanding its complex
combination may open up new solutions.

Symptoms

Cognitive symptoms in MDD

Cognitive symptoms of depression are a common problem despite the availability of many treatment options and should be considered as part of the successful management of patients due to their high impact on quality of life.1,2

Additionally, these symptoms may be present regardless of improvements in other depressive symptoms2-6 and are a risk factor for disease relapse.7

This website is dedicated to exploring this developing area of research and furthering our understanding of the impact of these symptoms on patients suffering from depression, as well as potential management approaches.

Image 1
Prevalence

Cognitive symptoms are prevalent

Studies have also shown cognitive symptoms are the second or third most commonly reported symptom experienced during an acute episode of depression, among the diagnostic criteria for depression.1,2

How common are cognitive deficits?

Video 1

A study of 487 adolescents during their first depressive episode found that ‘diminished ability to think or concentrate or indecisiveness’ was reported by 83.2% of patients and was the second most common symptom. This included 76.8% of patients experiencing difficulties with concentration and thinking, and 45.4% with indecisiveness.3

A 3-year prospective study of 267 initially depressed primary care patients showed that cognitive symptoms, lack of energy and sleeping problems were present 94%, 90% and 85% of the time during major depressive episodes (MDEs) and 44%, 35% and 39% of the time during remissions, respectively.1

Further studies have confirmed that the cognitive symptoms of depression can persist even when patients are responding to treatment or are in remission.

A report characterizing residual depressive symptoms in a large sample of representative outpatients from the STAR*D study demonstrated that cognitive symptoms* persists in patients with MDD who have responded, but not remitted, to SSRI antidepressant medication, with as many as 71% of patients experiencing residual decreased concentration/decision making.4

*Concentration difficulties, indecisiveness and forgetfulness

Impact

The impact of cognitive symptoms

A study investigating the link between cognitive dysfunction and functional outcome in patients with major depressive disorder (MDD) demonstrated that cognitive performance was strongly associated with functionality, even when controlling for residual depressive symptoms.1

Presenteeism in depression

Video 2

It is thought that the presence of cognitive symptoms can significantly influence functional recovery.1 This makes addressing cognitive symptoms an important target for research.

Current research is exploring the degree to which cognitive symptoms, such as concentration difficulties, indecisiveness and forgetfulness, can explain impaired life functioning for a patient suffering from depression even 6 months after hospitalisation.1 After accounting for the effect of residual depression, psychosis and disabling co-morbidities at follow-up, studies have shown that cognitive symptoms are strongly associated with life-function disabilities 6 months after discharge from the hospital.1

Not only do cognitive symptoms of depression significantly impair daily functioning, they also increase the likelihood of relapse.1,2

Persistence

Persistence & residual symptoms

The most prevalent residual symptoms of MDD, including fatigue and insomnia, have been studied for their impact on patient relapse. Many studies have found lack of full remission to be a key factor in patient relapse.1,2,3

Consequences of persistent cognitive symptoms

Video 3

Studies have also shown that residual symptoms are common in patients treated for MDD. In the STAR-D trial step 1, 15% of the patients responded but did not remit. Out of these responders the most frequently reported symptoms, assessed with the QIDS-SR16, were:

  • midnocturnal insomnia (81,6%)
  • sad mood (70,8%)
  • decreased concentration/decision making (69,6%)
  • low energy (63,3%)

Cognitive symptoms

Video 4

In one 3-year prospective study in 267 adult patients, cognitive symptoms, lack of energy, and sleeping problems were present 94%, 90% and 85% of the time during major depressive episodes and 44%, 35% and 39%of the time between major depressive episodes, respectively.5 The study defined cognitive symptoms as diminished ability to think or concentrate and/or indecisiveness.5

Furthermore, a cross-sectional study of the prevalence of cognitive and physical symptoms among 117 MDD patients in remission also showed that cognitive symptoms (defined by the study as apathy, inattentiveness, forgetfulness, word-finding difficulty, and mental slowing) were reported by more than 30% of the responders on antidepressants. In addition, lack of energy was present in almost 49% of patients and sleeping problems were present in greater than 50% of patients.1

The cognitive symptoms of MDD, such as lack of concentration, forgetfulness, and indecisiveness, are often refractory.1,5,6

Residual symptoms and persistence of cognitive difficulties may be associated with the impairment of daily functioning that can remain despite improvements in depressive symptoms.7 It is therefore recommended that patients with residual symptoms should continue treatment until these symptoms become of a minor degree or completely subside.8

Disclaimer

Disclaimer & Privacy Statement

This website is owned and provided by:

H. Lundbeck A/S
Ottiliavej 9
2500 Valby
Denmark
Company registration number: 56 75 99 13
Telephone number: + 45 3630 1311
Contact us

Lundbeck is firmly committed to protecting the privacy of information we may collect from our online visitors. It is our intent to balance our legitimate business interests in collecting and using information received from and about our online users with their reasonable expectations of privacy. The following describes how we handle information collected as well as our dissemination practices for this website.

Cookies

When you visit this website your online device will automatically receive one or several cookies, which are transferred from this website to your internet browser.

What is a cookie?

A cookie is a small text file. It does not contain any personal information and is not able to collect information.

Two types of cookies can be used, "session-only" and "persistent". "Session-only" cookies are deleted when you end your browser session.

"Persistent cookies" remain on your device for the time period set in the cookie after which time they delete themselves. However, these cookies may be renewed every time you visit the website.

Why does Lundbeck use cookies?

Lundbeck is interested in knowing how the content provided is used. The information is used only to define where the visitors come from, what content is viewed and for how long. These cookies allow a more detailed level of tracking to fine tune our usage reports and thereby gain a better understanding of potential areas of improvement so that Lundbeck can continue to improve the relevance of and accessibility to the content we provide. This information cannot be used to identify a visitor as an individual.

How to avoid or delete a cookie

Most internet browsers allow you delete, block or alert you before a cookie is saved/stored on your online device. Depending on which online device you use, you can in its settings get information on how you set your browser to handle cookies.

Can I still visit the website if the cookie-function is disabled?

Yes. Should you have cookies disabled on your online device, you will continue to have the same access to the website content as with cookies enabled. However, some functions such as surveys and tools might operate with reduced functionality or not at all.

Third parties

This website uses cookies from Google analytics, Add This and "The newsmarket" to measure the traffic on the website.

Processing of personal information

Personally identifiable information and purposes

Lundbeck collects personally identifiable information such as names, addresses and email addresses when this is provided voluntarily by you or if you have given your consent.

Your data may be processed for the following purposes: To provide access to a specific part of our website, to contact you regarding the services you have requested, to provide the services you have requested, such as email notifications and orders, to carry out surveys about how to improve our service to you, such as visitor feedback, to supply a reasonable level of services to our users and for other purposes directly requested by you.

Disclosures and onward transfers

Lundbeck guarantees that your personal data will not be disclosed to third parties under any circumstances without your explicit informed consent except as described in this policy.

As mentioned, Lundbeck will not share other personal information without your explicit consent unless disclosure is reasonably necessary in Lundbeck's opinion to: enforce an agreement between you and Lundbeck; comply with legal process, including, but not limited to, civil and criminal subpoenas, court orders or other compulsory disclosures; respond to service inquiries; or protect the rights, property, or personal safety of Lundbeck, the users of the website or the public.

The information originating from the cookies will only be used by Lundbeck and our relevant partners to increase the quality of content, service and support to our visitors. Some of this information may be made public from time to time; however, it will only be in an aggregate and non-personally identifiable form, such as how many visitors the website has had. The type of information gathered includes origin of the user, type of browser, operating system and search engine used, and length of visit on the site.

Your personal data is stored on Lundbeck computers/servers within the European Economic Area and may, for the purposes described above, be shared with other members of our Group. Lundbeck and/or other members of our Group within the European Economic Area may transfer your personal data to third party processors inside the European Economic Area.

Third Party Data Processors

Lundbeck may choose to use data processors, e.g. hosting companies, and your personal data may then be transferred to and stored by third party specialists engaged by Lundbeck or other members of our Group, who will process your data on Lundbeck's behalf (i.e. as data processors) and assist in the provision of the content and services you request. These third party providers will be obligated by Lundbeck to safeguard the confidentiality of your data and to take adequate technical and organizational measures to protect your data against (a) accidental or unlawful destruction, loss or alteration, (b) Unauthorized disclosure or abuse, or (c) other unlawful processing.

Storing of Data (Data Retention)

Lundbeck will keep your personal data only for as long as reasonably necessary for the purposes for which it was collected or to comply with any applicable legal or ethical reporting or document retention requirements.

Security measures

Lundbeck will see to that the recorded data, including your personal data, is handled carefully and protected properly following the currently applicable safety standards.

Lundbeck regularly audits its system for possible vulnerabilities and attacks. However, since the internet is not a 100% secure environment, Lundbeck cannot ensure or warrant the security of information you transmit to Lundbeck. Emails sent via the website are not encrypted, and Lundbeck therefore advise you not to communicate any confidential information through these means.

How can you gain access to, modify or remove information?

You have the right to be informed about the information held by Lundbeck about you, and to review and modify the information in the event your information stored by us is incorrect, and to request that we delete such information in the event your information as stored by us is incorrect.

At any time you are also entitled to recall the consent you have given with respect to Lundbeck's use of your personal information. If you have requested to receive information from Lundbeck, e.g. newsletters etc, and do not wish to be receive further information, you can easily opt out of receiving further information from us.

You can find our contact information at the top of this document.

Direct communication

Any questions, comments, suggestions, and so on that you may forward or transmit via the website will to the fullest extent permitted by applicable law become and remain the property of Lundbeck and will be treated as non-confidential, non-proprietary information that Lundbeck may use in any fashion and for any purpose whatsoever.

Disclaimer of liability

Lundbeck ensures that reasonable care is being taken to ensure that the website content is accurate and up-to-date, but all information is provided ‘as is’ and Lundbeck makes no warranties or representations of any kind as to accuracy, sequence, timeliness or completeness of the website content and may at any time at its sole discretion change or replace the information on the website and discontinue distributing the site without prior notice. The website may contain information on diseases and treatments: this information is intended for general guidance only and must never be a substitute for advice provided by a doctor or other qualified healthcare professional. To the extent permitted by mandatory law, Lundbeck shall not be liable for any direct, incidental, consequential, indirect or punitive damages arising out of access to or use of any content on this site, including viruses, regardless of the accuracy or completeness of any such content. If you suspect you have a health problem, we strongly recommend that you contact your physician.

Links to other websites

The website may contain links to third party websites. Lundbeck disclaims any control over, relationship with, or endorsement of these sites and shall not be liable for any damages or injuries arising from the content of such sites. Links to other websites are provided only as a convenience and Lundbeck encourages that you read these third party websites' privacy statements.

Intellectual property rights

The content of the website is subject to copyright protection and other intellectual property rights. The company names, trade names, logos and all product names are trademarks owned by Lundbeck. Any misuse of these trademarks is expressly forbidden. The content of the website may not be copied other than for personal and non-commercial use, with all copyright or other proprietary notices retained. Except as expressly provided above, it is not permitted to copy, display, download, modify, reproduce or retransmit any information on this website without the express written consent of Lundbeck.

Children

This website is not intended or designed to attract children under the age of 18 years. We do not collect personally identifiable data from any person we know to be under the age of 18 years.

Changes and questions

Any changes to this privacy policy will be communicated promptly on this page. If you have any further questions concerning Lundbeck’s privacy policy or the website in general, please do not hesitate to contact us .

Governing law and venue

This disclaimer and the contents of this site shall be governed and interpreted by Danish law without regard to its conflict of law rules. Any dispute arising out of or in relation to this disclaimer shall, if it cannot be solved amicably, be decided exclusively by the Danish Courts in Copenhagen, Denmark.

Last updated March 2012

© 2012 H. Lundbeck A/S