Effect Of Escitalopram Combined With Aripiprazole On Cognitive Function And Clinical Efficiency In Patients With First-Episode Depression

Objective:To explore the effect of escitalopram combined with aripiprazole on cognitive function in patients with depressive disorder,and to evaluate the clinical efficacy and safety of the therapy.Method:70 patients with first-episode unipolar depressive disorder were randomly divided into study group and control group,and received escitalopram combined with aripiprazole（5mg/day）and escitalopram alone respectively for 8 weeks.The severity of illness was assessed by using the Hamilton Rating Scale for Depression（HAMD）at baseline,at the 4th and 8th weekends,and cognitive function was assessed by using the THINC integrated tool（THINC-it）,the Wisconsin Card Sorting Test（WCST）,and the Continuous Performance Test（CPT）.Rating Scale for Extrapyramidal Side Effects（RSESE）and the adverse event record sheet were used to assess adverse reactions.Results:1.With the passage of time,HAMD scores significantly decreased in both groups(P_time<0.001),but there was no significant difference in the HAMD score reduction rate between the groups[（46.70±14.23）%vs.（48.22±10.27）%,P>0.05],there was no significant difference in the treatment outcome between two groups（Z=-0.724,P>0.05）,and there was not any significant difference in the HAMD and HAMA factor scores（P>0.05）.2.The performance of executive function,memory,attention and processing speed in both groups significantly improved compared with the baseline.（1）WCST:The total number of responses completed in the study group decreased more than the control group(P_time*group<0.05),and significantly improved at the end of 8th weeks compared with the baseline（P<0.01）.There was no significant difference in the control group after treatment;The correct responses of the study group at the 4th weekend,the 8th weekend and the control group at the 4th weekend increased significantly compared with the previous time point,and for the number of false responses,the study group decreased relatively more(P _time*group<0.05);The number of errors significantly improved from the previous time point,while the improvement was only observed at the end of the 8th week in the control group.（2）THINC-it:The CRT scores of the study group at the 4th weekend,the 8th weekend and the control group at the 4th weekend significantly increased compared with the previous time point.There was no significant difference in the control group at the 8th weekend compared with the 4th weekend,while the study group’s score at the 8th weekend was significantly higher than that at the 4th weekend in control group（P<0.05）;the DSST scores of the study group increased significantly at the end of the 4th and the 8th weekend compared with the previous time point.These improvements were not observed in the control group,but only at the end of the 8th weekend compared with the baseline.At this time,the score of the study group was significantly higher than that in control group（P<0.05）.（3）CPT:In the double-digit results,the reaction time at the end of4th and 8th weekends in the study group significantly decreased compared with the previous time points,while the improvement was only observed at the end of the 8th weekend in the control group;In the triple-digit results,the drop in the number of missed answers in the study group was relatively larger(P_time*group<0.05).Compared with the previous time points,the number of missed answers in the study group at the 4th weekend,the 8th weekend and the control group at the 4th weekend significantly decreased,and the number of missed answers in the control group at the 8th weekend was not significantly different from that at the4th weekend;In the four-digit results,the drop in the number of missed answers in the study group was relatively greater with the passage of time(P_time*group<0.05).Compared with the previous time point,the number of missed answers in the study group was significantly lower than that in the control group,and there was no significant change in the control group.3.Correlation between cognitive function and disease severity（1）WCST:The total number of responses completed,the number of false responses,the number of persistent responses,the number of persistent errors,the number of non-persistent errors,the number of responses required to complete the first classification were all positively correlated with the HAMD scores,the number of completed classifications,conceptualization,the percentage of horizontal response were all negatively correlated with the HAMD scores.（2）THINC-it:DSST scores and PDQ-5D scores were both negatively correlated with HAMD scores.（3）CPT:The number of wrong answers and missed answers in the double-digit and triple-digit numbers were all positively correlated with HAMD scores.4.Correlation between cognitive function and prolactin level（1）WCST:The number of completed total responses,the number of false responses,the number of persistent responses,the number of persistent errors,the number of non-persistent errors,and the number of responses required to complete the first classification were all positively correlated with the concentration of prolactin,and the number of completed classifications,the number of correct responses and the percent of responses at the conceptual level were all inversely correlated with prolactin concentration.（2）THINC-it:PDQ-5D,DSST,TMT scores were all negatively correlated with prolactin concentration.（3）CPT:The average reaction time was positively correlated with the prolactin concentration.5.There was no significant difference in RSESE scores between two groups at the 4th and 8th weekends of treatment（P>0.05）.The adverse reactions in the two groups were mild,and there was no significant difference in the incidence of adverse reactions between two groups（P>0.05）.Conclusion:1.The overall cognitive function,executive function,processing speed and attention level of patients with depressive disorder were negatively correlated with the severity of depression,that is,cognitive function may decrease with the increase of the severity of depression.2.Escitalopram combined with low-dose aripiprazole and the former alone can effectively improve the cognitive function of patients with depressive disorder.Compared with escitalopram alone,combining with low-dose aripiprazole can improve cognitive function.The improvement in cognition is more pronounced with earlier onset.3.Escitalopram combined with low-dose aripiprazole and the former alone can significantly improve depressive symptoms and anxiety symptoms in patients with depressive disorder.Compared with escitalopram alone,there was no increase in antidepressant efficacy when combining with low-dose aripiprazole.4.Compared with escitalopram alone,the combination of low-dose aripiprazole did not bring more adverse reactions.5.Cognitive functions of patients with depressive disorder was negatively correlated with serum prolactin level.