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.
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
My results are shown 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, and 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 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.
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 think I should make sure that I’m not just accepting the status quo by default.