Academic journal article Psychiatry Journal

Cognitive Function before and during Treatment with Selective Serotonin Reuptake Inhibitors in Patients with Depression or Obsessive-Compulsive Disorder

Academic journal article Psychiatry Journal

Cognitive Function before and during Treatment with Selective Serotonin Reuptake Inhibitors in Patients with Depression or Obsessive-Compulsive Disorder

Article excerpt

1. Introduction

Selective serotonin reuptake inhibitors (SSRIs) are the first-line drug treatment of depression and obsessive-compulsive disorder (OCD). Monotherapy with this class is often recommended for patients primarily diagnosed with these conditions [1, 2].

Despite the potential usefulness of SSRIs, they could cause unwanted side effects such as headaches, weight gain, sexual dysfunction, changes in sleep patterns, and gastrointestinal problems [3]. Originally, SSRIs did not appear to cause cognitive impairment, but nowadays there are conflicting evidences regarding this side effect and many patients complain of memory loss during their course of therapy with SSRIs [4, 5].

The aim of this study is to assess the effect of SSRI drugs on cognitive function of patients with depression or OCD, in acute phase of therapy. In this phase, knowledge and management of side effects are very critical for the patient's compliance to therapy, since these patients might not be motivated enough to cope with adverse effects along with their psychiatric symptoms [6]. In many health problems, drug induced memory loss can be an important cause of medication nonadherence [7, 8].

Current study evaluates the patients' cognitive function, prior to taking SSRIs and throughout the acute course of their therapy.

2. Methods

This analytic-descriptive study was conducted in a psychiatric outpatient clinic from April to September 2015. It was permitted by Ahvaz Jundishapur University of Medical Sciences ethics committee. Among patients diagnosed with depression or OCD by a board certified psychiatrist, those who currently were not under any treatment for mental or psychiatric disorders and were candidates of receiving a drug from SSRI class as monotherapy were asked to participate in this study. Inclusion criteria consisted of age between 18 and 60 years, no diagnosed cognitive impairment or mental retardation, no other comorbid disorders in Axis I, the ability to write and read, no visual or auditory impairment, no history of loss of consciousness after head trauma or brain surgery, and no history of using psychoactive drugs such as antidepressants, neuroleptics, benzodiazepines, antiepileptics, or opioids within 14 days prior to the study. Individuals with memory loss complaints in daily functioning would not be included either. If the patient developed any condition in which the use of SSRIs was contraindicated or any disability which interfered with performance of cognitive tests, he/she would be excluded from the study. In addition, patients who stopped their medication for seven consecutive days or did not adhere well with their drug therapy would be excluded. All patients signed a consent form prior to the study.

Several approaches have been developed to help with the diagnosis of cognitive impairment. Some of these tests are Montreal Cognitive Assessment, DemTect, Short Test of Mental Status, Clinical Dementia Rating, and Mini-Mental State Examination (MMSE) [9-12]. Among these, MMSE test is the only valid and reliable test in Farsi; thus, we used this tool for our patients [13, 14]. Aspects of cognitive function assessed by this test include orientation, registration, attention, calculation, recent memory, and language skills. Seyedian et al. translated the Farsi version of MMSE. Its reliability based on Cronbach's Alpha is 81% and a cut-off point of 22 showed a sensitivity of 90% and specificity of 93.5% [13, 14].

The patients' demographic data (age, gender, level of education) were collected in the first visit (week 0 of therapy) and MMSE (a 30-point test) was performed at weeks 0, 3, 5, and 8 of drug therapy. Each patient's drug regimen (type of drug and dosage) remained fixed throughout this 8-week period. If for any reason the patient needed a dose reduction or increase or medication discontinuation, he/she would be excluded from the study The response to therapy and clinical improvement of OCD/depression signs and symptoms would also be evaluated and recorded. …

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