Cognitive Residual Symptoms After Depression

Cognitive residual symptoms after major depressive disorder (MDD), commonly referred to as depression, are symptoms that are present after completing therapy and/or pharmacological treatment. These symptoms are often overlooked, given that the individual is in remission. However, these symptoms are very common and have been shown to negatively affect an individual’s well-being.

Key takeaways:
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    Cognitive residual symptoms are very common.
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    Cognitive residual symptoms affect an individual’s well-being and life satisfaction.
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    The extent of cognitive residual symptoms is linked with the number of MDD episodes and can predict relapse.

What are cognitive residual symptoms?

The standard of care in MDD is complete remission. The treatment aims to return a person to a healthy functioning individual — cognitively, socially, and physically. MDD’s core symptoms include, but are not limited to, low mood, lack of interest in surroundings or activities that previously were pleasurable, and lack of positive affect.

After addressing the MMD, the common expectation is that an individual will return to the pre-MDD levels of productivity and performance at work and/or with family. However, research shows that many individuals in remission struggle with cognitive residual symptoms. These symptoms have an overall negative effect on an individual’s well-being. They are linked to negative thoughts (remuneration) and a loss of sense of self-worth. Given these negative outcomes, the severity of the cognitive residual symptoms is highly correlated with the risk of relapse.

Cognitive residual symptoms vary in severity and symptomology. However, they most commonly affect the following domains of life and functioning:

Fatigue

An individual may feel persistent tiredness or weakness. This symptom can affect physical, psychological, or cognitive aspects. For example, they feel too tired to talk about their day or too weak to walk the dog or go to the grocery store.

Physical symptoms

Individuals may experience difficulty performing basic or minor tasks that were previously done with ease. They may lack the previous skill level, which can make the task overwhelming.

Cognitive dysfunction

Individuals in remission often report experiencing memory problems, especially working memory. For example, they struggle to remember a few items on their grocery list or forget tasks they need to do. Individuals also commonly experience difficulties with maintaining attention. For example, concentrating on the entire duration of a work meeting or lecture is tough. In addition, research has shown that many individuals in remission perform worse on neuropsychological tests when compared to healthy individuals. These symptoms are especially challenging for individuals who hold academically or occupationally challenging roles.

Sleep disturbances

Individuals can experience difficulty with normal sleep patterns, for example, maintaining or initiating sleep. In addition, they may experience circadian misalignment, i.e., difficulties adjusting their sleep schedule to the socially constructed day. For example, individuals oversleep or have trouble waking up on time for school or work.

How common are cognitive residual symptoms?

Cognitive residual symptoms are very high in people treated for MDD. Some studies suggest that more than 90% of individuals in complete remission will experience at least one cognitive residual symptom. The scientific literature suggests that the negative effects of cognitive residual symptoms are most pronounced in memory — long and short term, with smaller yet present deficits in most other cognitive domains. Additionally, it is proposed that individuals who have suffered from MDD will perform worse on 73% of neuropsychological tests compared to individuals with no history of MDD.

Experts also suggest that each major MDD episode will have a neurobiological scarring effect. This means that the more MDD episodes a person experiences, the worse the cognitive residual symptoms appear in complete remission. Interestingly, more pronounced residual cognitive symptoms seem to predict MDD episodes. This can eventually result in persistent cognitive problems and greatly increase the relapse rate.

What help is available?

If you believe you or a close one is experiencing cognitive residual symptoms, share this with your dedicated clinician. They can offer additional help based on individual needs.

Currently, there are several web-based intervention techniques aimed at helping individuals with cognitive residual symptoms. Support groups are available for individuals in remission, as well as for family members and friends, which address the negative feelings you may experience as a result of cognitive residual symptoms. Finally, if you feel that you need more personalized help, a psychologist can help you cope with symptoms. Consider seeking out a dedicated mental health professional — especially if you are experiencing negative feelings about your self-worth or life satisfaction.

The primary aim of therapeutic and web-based approaches in the case of cognitive residual symptoms is to treat the symptoms that most negatively affect an individual’s performance. These approaches focus on:

Remediation techniques. Practicing cognitive skills with pen and paper or on web-based platforms and doing various exercises and tasks to train and increase cognitive abilities.

Compensatory strategies. As the name suggests, it proposes alternative ways of performing the same task. For example, these would involve strategies for improving memory skills (e.g., grocery lists).

Adaptive approaches. These approaches refer to environmental changes. For example, individuals use particular aids to improve functioning. Those can be as simple as making effective to-do lists, setting electronic reminders, or carrying a voice recorder to themselves “notes”.

If you have a loved one in remission, it is important to understand that they might experience additional struggles, even though they are not depressed and that getting back to “normal” may take time. Talking to your close ones, expressing your support, and offering assistance may help them feel more positive and accepted.

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