A pilot study on improvements in attention function in major depressive disorder after 12 weeks of escitalopram monotherapy or combined treatment with agomelatine

Zhe Li; Ting-Ting Wu; Yi-Ting Xiong; Xin-Yang Zhang; Yan-Ping Bao; Li-Bo Guo; Bao-Jie Han; Su-Xia Li; Yu-Feng Wang; Lin Lu; Xue-Qin Wang

doi:10.3389/fpsyt.2023.1188175

A pilot study on improvements in attention function in major depressive disorder after 12 weeks of escitalopram monotherapy or combined treatment with agomelatine

Front Psychiatry. 2023 Jun 22:14:1188175. doi: 10.3389/fpsyt.2023.1188175. eCollection 2023.

Authors

Zhe Li¹, Ting-Ting Wu², Yi-Ting Xiong¹, Xin-Yang Zhang¹, Yan-Ping Bao³, Li-Bo Guo¹, Bao-Jie Han¹, Su-Xia Li³, Yu-Feng Wang¹, Lin Lu^{1

4}, Xue-Qin Wang¹

Affiliations

¹ Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China.
² Beijing Key Lab of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China.
³ National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, China.
⁴ Peking-Tsinghua Centre for Life Sciences and Peking University-International Development Group, McGovern Institute for Brain Research, Peking University, Beijing, China.

Abstract

Objective: This study aimed to explore both impairments in attention function in patients with major depressive disorder (MDD) and the efficacy of escitalopram monotherapy or combination therapy with agomelatine.

Methods: A total of 54 patients with MDD and 46 healthy controls (HCs) were included. Patients were treated with escitalopram for 12 weeks; those who presented with severe sleep impairments were also given agomelatine. Participants were evaluated using the Attention Network Test (ANT), which included tests of alerting, orienting, and executive control networks. Concentration, instantaneous memory, and resistance to information interference were tested using the digit span test, and the logical memory test (LMT) was used to evaluate abstract logical thinking. The Hamilton Depression Rating Scale-17 items, Hamilton Anxiety Rating Scale, and Pittsburgh Sleep Quality Index were used to assess depression, anxiety, and sleep quality, respectively. Patients with MDD were assessed at the end of weeks 0, 4, 8, and 12. HCs were assessed once at baseline.

Results: Compared with HCs, patients with MDD showed significantly different alerting, orienting, and executive control functions of attention networks. Treatment with escitalopram alone or combined with agomelatine significantly improved LMT scores at the end of weeks 4, 8, and 12 and restored scores to the level of HCs at the end of week 8. Total Toronto Hospital Test of Alertness scores in patients with MDD increased significantly after 4 weeks of treatment. The ANT executive control reaction time in patients with MDD decreased significantly after 4 weeks of treatment, with this decrease lasting until the end of week 12, but scores did not return to the levels of HCs. Combined treatment with escitalopram and agomelatine led to more improvement in ANT orienting reaction time and was accompanied by a greater reduction of total scores on the Hamilton Depression Rating Scale-17 items and Hamilton Anxiety Rating Scale compared with escitalopram monotherapy.

Conclusions: Patients with MDD showed overall impairments in three domains of attention networks as well as the LMT and a test of subjective alertness. Escitalopram monotherapy significantly improved the LMT scores and the executive control function scores in the ANT at the end of the fourth week of treatment, and the improvement was more extensive with combined escitalopram and agomelatine treatment.

Keywords: agomelatine; attentional networks test; cognitive function; efficiency; escitalopram; executive control of attention; logical memory; major depressive disorder.

Grants and funding

This work was supported by the STI2030-Major Projects 2021ZD0201900 (Project 5, No. 2021ZD0201905), the Beijing Municipal Science and Technology Commission, No. Z191107006619091, Capital's Funds for Health Improvement and Research of the Beijing Municipal Commission of Health, No. 2022-2-4115, and Beijing Municipal Science and Technology Commission (No. Z161100000516128).