The Efficacy of Cognitive Remediation in Depression: A Systematic Literature Review and Meta-Analysis

Background: Individuals with major depressive disorder often experience cognitive deficits. Cognitive remediation (CR) is an intervention aimed at improving cognition in psychiatric disorders. However, its efficacy on global and specific domains of cognition in adults with depression requires systematic investigation. Further, given individual differences in treatment outcome, moderators of CR effects in depression need to be identified. Methods: We performed a systematic review and meta-analysis of published controlled trials of CR in adults with depression. We analyzed results from eight studies to estimate the efficacy of CR on global cognition and on six cognitive domains. We also examined three potential moderators, namely session format (individual vs. group), treatment duration, and participants' age. Results: CR was found to improve global cognition (g = 0.44), verbal memory (g = 0.60), attention/processing speed (g = 0.41), working memory (g = 0.35), and executive functioning (g = 0.30). No significant improvements emerged for visuospatial memory and verbal fluency. Furthermore, no significant moderating effect of participant's age, session duration or session format were observed. Limitations: Conclusions are limited by the small number of studies, the heterogeneity in cognitive measures, and the lack of indicators of everyday functioning. Conclusion: Our meta-analysis supports the use of CR in improving global cognition in adults with major depressive disorder with a moderate effect size and this efficacy varies between cognitive domains.