The course of social cognitive and metacognitive ability in depression: Deficit are only partially normalized after full remission of first episode major depression

OBJECTIVES: Research has suggested that patients suffering from major depressive disorder (MDD) experience deficits in the related domains of social cognition and metacognition. Most research has focused on detecting deficits among persons who are acutely symptomatic. Thus, little is known about whether these deficits persist after symptoms have remitted. As a first, this study investigated social cognitive and metacognitive deficits in patients with MDD in the acute and remitted state.

DESIGN: Longitudinal case-control.

METHODS: Forty-four drug-naïve depressed patients and an equal number of matched healthy controls were assessed in multiple domains of social cognition including theory of mind, social perception, and metacognition. Additionally, a comprehensive neurocognitive (non-social) test battery was utilized. Following baseline assessment, patients were enrolled in an outpatient treatment programme. Patients reaching remission within 6 months (n = 29) were reassessed 6 months post-remission. Included for analysis were only patients who followed a course of remission (n = 29) and their paired healthy controls (n = 29).

RESULTS: Analyses of variance revealed that remitted patients performed significantly better at retest than at baseline on nearly all measures. These effects withstood adjusting for test-retest effects. Moreover, remitted patients performed up to level of healthy controls on some but not all social cognitive tasks and metacognition at retest.

CONCLUSIONS: Overall, results suggests that social cognitive and metacognitive ability may improve with symptom remission in major depression although it may not reach a level equal to persons who have never experienced depression.

PRACTITIONER POINTS: Many with first-episode depression experience deficits in social cognition. When first-episode depression remits, social cognition may improve. After remission, first-episode depressed patients may still experience deficits in social cognition. We have yet to determine whether social cognitive deficits existed prior to the onset of depression. Longer-term longitudinal studies of social cognition in depression are needed. Treatment was pharmacological and non-manualized psychotherapy, the effects of which were not controlled for. Sample sizes were modest, which must caution against generalization of the results.