Cognitive dysfunctions in depression : underestimated symptom or new dimension?

Cognitive deficits constitute an integral part of clinical picture of depression, but often not enough attention has been paid to these deficits, mainly because of the presumption that they are secondary to typical depressive symptoms. It is considered that cognitive impairment is one of the main causes of depressive patients’ poor functioning. Cognitive deficits are observed already in the first depressive episode. They may correlate with the severity of depression, with the patient’s age and level of education. They may persist regardless of the improvement of depression during treatment. Cognitive deficits in depression are divided into “cold” which are not related to emotions, and “hot” – related to emotions. The “cold” deficits are supposed not to respond to antidepressants and seem to persist even in clinical remission. Vortioxetine is a novel antidepressant with a unique mechanism of action: it acts through the serotonine reuptake inhibition, but works also as 5HT1A agonist, as well as partial agonist of the 5HT1B receptor and antagonist of the 5HT1D, 5HT3 and 5HT7 receptors. In preclinical studies vortioxetine showed the normalization of serotoninergic, noradrenergic, and dopaminergic transmission, additionally through GABA-ergic and glutaminergic effects. It has antidepressive property, it proved to be efficacious in various types of depression (severe, depression with anxiety, and depression in elderly); it also proved to be efficacious in those patients who did not respond sufficiently to SSRIs and SNRIs treatment. Vortioxetine is also beneficial for cognitive functions in depressed patients.