Despite what the title might suggest, this post isn’t about me being self-critical. I’ve been struggling for months with cognitive symptoms of depression, and on a daily basis I notice that it impairs my overall functioning. But it’s not something I’ve ever had much of an objective sense of, until I tried the THINC-it test.
THINC-it to measure cognitive function in depression
As a nurse working in psychiatry, I need to keep up my knowledge base, which I often do by watching webinars. I recently 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 mood disorders research. So much of what he said resonated that I felt like he could have been talking about me. Â
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. Cognitive symptoms of depression can include effects on memory and executive functioning.
Dr. McIntyre and his colleagues recently developed the THINC-it instrument 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, which are named Spotter, Symbol Check, Code Breaker, and Trails. The test is intended for use in research, and it’s not meant for self-testing, but as soon as I finished the webinar, I downloaded the tool and gave it a go.
My THINC-it results
You can see my results above from January 2018 (the top image) and July 2021 (the bottom image). The ball on the left is my self-report of cognitive symptoms. The next four balls represent the four different tests. Green is good, and red is bad. My results show clear impairment.
It’s interesting to see an objective reflection of what I’ve 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. Also, the difficulties I have with basic tasks don’t match up with my high IQ and graduate degree.
Implications for depression treatment
One thing that Dr. McIntyre mentioned, that I’d heard before in other webinars, is that vortioxetine is the only antidepressant that’s been shown to improve cognitive functioning. This occurs 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 the THINC-it 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. The most prominent symptoms I’m currently having are cognitive. While my current meds help somewhat, it just doesn’t look like they’re going to fully treat these symptoms.
Now what?
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 I’m able to tell him what I’m considering and get 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 shouldn’t just accept the status quo by default.
Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.
Good for you to not accept status quo. Wish you luck, must be a tough fight. Hope you will get good help. Have heard, meditation and exercise help. Possibly having friends too helps.
Thank you!
Ah! This just explained why I feel stupid! I’ve been thinking my reduced cognitive function must just be a consequence of PTSD and not being diagnosed for two years, but this makes so much sense, especially in the context of how I feel as I transition off of Escitalopram. Still feel stupider, but feel like I have more creative function over the last two weeks. I hope you resolve the best option for your point in this journey, and in the meantime know that sharing your experience has really helped me!
Glad you’re starting to get your creativity back!
Me too! Didn’t even realize it was gone…
I can totally relate. I used to balance my checkbook, lesson plan, create a syllabus…and now I can barely fill out a form.
Yeah, that contrast in functioning can be so frustrating.
Woa I had not considered this. I was blaming it all on my lack of motivation and ability to kick myself in the ass and be able to perform as good as I did 2 years ago at work. Now to think that may be gone forever… scary stuff. I also feel like I should get a psychiatrist -just in case- I get much worst and need to have my medication looked into more closely. Seeing my therapist next week, I’ll see what he thinks of this whole idea of the cognitive deficiencies and psychiatrist added to the team.
A few years ago I took an IQ test for my psychologist. I had taken IQ tests before for gifted classes and such and this time I didn’t score nearly as well as I had in the past. I couldn’t help but wonder if my ptsd, depression, anxiety, and my physical problems (fibromyalgia and cfs which can also cause cognitive issues) weren’t playing a role in the decrease. Even my psychiatrist now says there is no way that lower test score accurately portrays my IQ now.
Yeah I feel like my smart brain is still in there, but I just don’t seem to be able to access it very much.
I haven’t taken any tests, but I also feel sometimes that I’m not functioning properly, which I put down to tiredness and also social anxiety at work when interacting with other people. This bit (“there are cumulative neurodegenerative effects, and outcomes are worse for people who don’t achieve full remission between episodes”) I found very scary, especially as I rarely go into remission and never for more than six months or so at a time. I guess I shouldn’t worry too much, as I did my BA and then my MA mostly while very depressed and my boss hasn’t complained about my work. Still, it is worrying.
Yes, it can be hard not to worry, but I guess in practical terms we can only do the best we can right now, and the future will bring what it brings.
I’m glad I found your post. I’ve written before about my worry over declining cognitive function and what it might mean for later in life. I will check out this diagnostic tool.
I found it to be an interesting tool as it was different from the typical cognitive impairment tests for dementia that don’t really capture some of the problems that depression cause.
So me….I stand in the middle of my house at times trying to figure out what the heck I was suppose to be doing. Scary when it’s just basic everyday task I’ve been doing my whole life.
Me too!
I’m 56 now, had depression and anxiety since I was 14. My brain/mind is not what it used to be! I can’t read a book, watch a film or TV as I’m unable to retain and understand. I can’t understand instructions or recipes, I can’t deal with money/financial issues. It’s all too difficult and stressful! I’m currently having CBT counselling and am on Venlafaxine and now about to start Mirtazapine as I’m struggling with this horrible, soul destroying illness. I’m trying everything, anything to help manage it better. I hate it but do accept its always gonna be here, be part of me. But it’s getting control of it, instead of it controlling me.