Despite what the title might suggest, this post isn’t about me being self-critical. I have been struggling for months with cognitive symptoms of depression, and on a daily basis I notice that it impairs my functioning. But it’s not something I’ve ever had much of an objective sense of.
Measuring cognitive function in depression
Until yesterday. As a nurse working in psychiatry, I need to keep up my knowledge base, and my preferred way to do that is by watching webinars. I decided I would get going right away for 2018, and watched a presentation on depression and cognition by Dr. Roger McIntyre, a professor of psychiatry at the University of Toronto who does some really interesting research. So much of what he said resonated that I felt like he was talking about me. He mentioned one study that found that people in their mid-thirties experiencing cognitive symptoms of depression performed about the same on cognitive testing tasks as people with a blood alcohol content of 0.08 (legally impaired to drive). Hmm, sounds about right.
Dr. McIntyre and his colleagues recently developed a tool called THINC-it to objectively evaluate cognitive performance in people with depression. There are 5 elements: a short patient self-report, and then 4 different computer-based cognitive tasks. As soon as I finished the webinar, I downloaded the THINC-it tool and gave it a go.
My THINC-it results
My results are in the picture above. The ball on the left is my self-report of cognitive symptoms, and the next four balls represent the four different tests. Green is good, and red is bad. I performed abysmally.
It’s interesting to see an objective reflection of what I have been feeling for some time now. It’s hard to be confident in my perspective of my own impairment when I’m stuck in the middle of it. I do recognize, though, that I’m much lower functioning than I used to be, and the difficulties I have with basic tasks don’t match up with my high IQ and graduate degree.
Implications for treatment
One thing that Dr. McIntyre mentioned that I’d heard before in other webinars is that vortioxetine is the only antidepressants that’s been shown to improve cognitive functioning across multiple domains independent of its effect on mood. I was actually saying to my doctor just the other day that maybe I should consider vortioxetine, but I’m not keen on rocking the boat by switching up my antidepressants.
Having the confirmation of this test, though, makes me think a little more strongly about making a change. Depression is bad for the brain; there are cumulative neurodegenerative effects, and outcomes are worse for people who don’t achieve full remission between episodes. For me right now the most prominent symptoms I’m having are cognitive, and while my current meds help somewhat, it just doesn’t look like they’re going to fully treat these symptoms.
So maybe it is time to try vortioxetine. Yet the idea of a major med change terrifies me, because it was so hard to hit on this particular combo when I was really sick 5 years ago. This is perhaps the only time I have regretted that I’m seeing a family doctor rather than a psychiatrist. I’m really happy with my doctor, and for the most part I’ve liked that I tell him what I’m considering and he gives me feedback on what he thinks is the best choice. When it’s something as big as this, though, a part of me wishes for someone who’s up on the latest knowledge in the field to take the lead. Then again, I don’t trust very easily, and I trust my current doctor.
I’m not sure what I’ll decide, but I think I should make sure that I’m not just accepting the status quo by default.
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