Breaking the cycle of depression Towards targeting multiple underlying mechanisms

This thesis focuses on cognitive remediation and recurrence prevention in Major Depressive Disorder (MDD).
It includes a meta-analysis on cognitive remediation in depression, which indicates that cognitive remediation improves cognitive functioning on the short term. Effects on depressive symptomatology and daily functioning, however, may have been overestimated.
Furthermore, we performed a 20-year follow-up of a randomized controlled trial on Preventive Cognitive Therapy in adults remitted from recurrent MDD. Although several limitations of this study preclude firm conclusions, the findings suggest long-term protective effects of Preventive Cognitive Therapy up to 20 years.
This thesis also includes the protocol for a randomized controlled trial on Preventive Cognitive Therapy augmented by online neurocognitive remediation therapy. We hypothesize that this combination of treatments, targeting multiple underlying mechanisms in depression simultaneously, may reduce chronicity in partial remitted MDD.
We conducted the first systematic review ever on neuropsychological performance validity in MDD. A surprisingly small number of studies reported on performance validity in MDD and about 94% of patients had valid performance. Our findings indicate that cognitive impairment might be limited in patients with valid performance and underscore the importance of taking neuropsychological performance validity into account.
Considering the new insights gained from the studies in this thesis, we conclude that an integrated approach of treatments may be required in order to optimize outcomes for patients with MDD.