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What’s Your New Name?
November 20, 2024
by Oneka McClellan

"And you will be given a new name by the LORD’s own mouth.” Isaiah 62:2c (NLT)

In the Bible, renaming was a sacred act. It signified that God wanted to change the direction of a person’s life so they could step into His purpose for them.  In Genesis 17:5-6, God spoke to the father of our faith, Abram: “… I am changing your name. It will no longer be Abram. Instead, you will be called Abraham, for you will be the father of many nations. I will make you extremely fruitful. Your descendants will become many nations, and kings will be among them!” (NLT).

Genesis 17:15-16 says, “Regarding Sarai, your wife her name will no longer be Sarai. From now on her name will be Sarah. And I will bless her and give you a son from her! Yes, I will bless her richly, and she will become the mother of many nations. Kings of nations will be among her descendants” (NLT).

“Abram” means “exalted father.” “Abraham” means “father of multitudes.” God was saying to Abram, Not only are you going to be a father, but you’ll be a father to many I’m changing the course of your life! As for Sarah, God changed her name’s meaning from “my princess” to “princess of all.”

You might be carrying all sorts of names today hurtful names from childhood or labels forced on you now. No matter what names you’re carrying, when you accept Christ as your Savior, God has unique, beautiful and wholly true names for you. As God told His people in Isaiah 62:2c, “You will be given a new name by the LORD’s own mouth.”

This is how the God of the universe sees you:

    Loved (Jeremiah 31:3).

    Saved (Ephesians 2:8).

    Redeemed (Galatians 3:13).

    Chosen (1 Peter 2:9).

    Right with God (2 Corinthians 5:21).

    Belonging to God (Isaiah 43:1).

    Daughter of God (Romans 8:16).

    Light of the world (Matthew 5:14).

    Overcomer (1 John 5:4).

These are just a few of the incredible names God has given you!  Sometimes we assume our names can’t change until we live in a new identity. But God changed Abraham and Sarah’s names years before their circumstances changed. Your identity is true and God’s vision for you is real even if you can’t see it exhibited in your current circumstances.  It’s time for us to say, “I’m God’s chosen daughter. He has a plan and purpose for my life. He’s bigger than my circumstances, my thoughts, and the labels the world puts on me. He has given me a brand-new name.”

If you’ve been a slave to your old mindsets or ways of living, God is ready to fill your heart with freedom and truth. He’s erasing those labels, lies and weights that enslave you. When we embrace our God-given names and own our God-given identity, we encourage those around us to do the same. Because God has called us each by name and what beautiful names they are!

https://www.psychiatrictimes.com/view/when-the-fog-doesnt-lift-targeting-cognitive-dysfunction-in-depression?ekey=RUtJRDpFOTIxNUQyMy03MkY0LTREOEUtQjRBRi1GNEI1RjcyQ0M4ODM%3D&utm_campaign=emailname&utm_medium=email&_hsenc=p2ANqtz-_xqo8-8CeBzYeWDGgKMFPVpW-BIgDnf6ko0TaLLwjQGKQ0vb6ccG8oYj-GJ50rniPmNQno5-Pd4OZ_ZlKIZegxCPSSCQ&_hsmi=360069957&utm_source=hs

Publication|Articles|March 24, 2025

Psychiatric Times
Vol 42, Issue 3

When the Fog Doesn’t Lift: Targeting Cognitive Dysfunction in Depression
Author(s)Susannah Murphy, DPhil, MA, MSc

Cognitive symptoms affect between 85% and 94% of patients with major depressive disorder. Despite this prevalence, cognitive dysfunction often remains undertreated and inadequately addressed in routine clinical practice.

SPECIAL REPORT: COGNITION

Clinical Vignette

“Sarah,” a 42-year-old marketing executive, presented with a major depressive episode of moderate severity. After 6 months of treatment with sertraline, her mood had significantly improved. She was sleeping well, had regained her appetite, and reported feeling much more positive about life. However, during follow-up, she expressed ongoing concerns about things at work.

“I can’t seem to keep up anymore,” she explained. “I make mistakes I never used to make, and I can’t focus during important meetings. Even though I do not feel as depressed, my mind feels foggy, and I am forgetting important details.”

Despite achieving remission of core depressive symptoms, Sarah’s persistent cognitive difficulties were threatening her career advancement and contributing to diminished self-esteem. Her case illustrates the common challenge of residual cognitive dysfunction even after successful treatment of mood symptoms in depression.

Incomplete Remission

Cognitive symptoms affect between 85% and 94% of patients with major depressive disorder (MDD), making them nearly ubiquitous in the clinical presentation.1 Despite this prevalence, cognitive dysfunction often remains undertreated and inadequately addressed in routine clinical practice. Growing evidence suggests that problems with cognition are a distinct clinical dimension of depression that are independent from mood symptoms and that may need targeted clinical management.

While diagnostic manuals emphasize problems in concentration, depression is associated with impairments across a much broader range of cognitive domains, including executive function, memory, processing speed, and attention.2 The degree of cognitive dysfunction has been shown to be associated with several clinical features, including severity of depression, age of onset, psychiatric comorbidity, educational background, and number of previous episodes. Cognitive dysfunction has been shown to be more pronounced in patients with recurrent depression.3,4

A particularly concerning aspect of depression treatment is the high rate of incomplete remission, especially regarding cognitive symptoms. Evidence shows that over 70% of patients who respond to selective serotonin reuptake inhibitor (SSRI) treatment continue to experience significant cognitive impairments, even when their mood symptoms have improved.5 These residual symptoms, particularly in domains of memory, concentration, attention, and executive function, present a substantial clinical challenge.

The consequences of untreated cognitive dysfunction are far-reaching. Ongoing cognitive problems are known to be a risk factor for subsequent relapse.6 These symptoms also significantly impact patients’ psychosocial functioning, often presenting greater barriers to occupational recovery than mood symptoms alone. Quality of life measures consistently show that cognitive difficulties interfere with workplace performance, social relationships, and daily functioning, even in patients whose emotional symptoms have improved with treatment.7,8

Current Pharmacological Approaches

Current treatments for depression, whether medication or therapy, produce only minimal improvements in cognitive function. A recent review highlighted that 95% of cognitive problems show little or no meaningful improvement after treatment.9 While a patient’s mood might get better, their ability to think clearly, remember information, and focus on tasks often remains impaired. This analysis also highlighted that with each episode of depression, some cognitive problems may worsen. Like scratches on a record, these scar effects are particularly noticeable in areas like sustained attention and verbal memory. This suggests that early intervention might be crucial in preventing long-term cognitive decline.

There is currently a lack of pharmacological treatments approved by the US Food and Drug Administration (FDA) to treat the cognitive symptoms of depression. SSRIs, while demonstrating reliable efficacy for core depressive symptoms, have shown limited impact on cognitive dysfunction. Meta-analyses of SSRI trials typically demonstrate small effect sizes for cognitive improvement.10,11 However, most benefits appear secondary to mood improvement rather than direct procognitive effects, and many studies do not appropriately control for nonspecific effects that can affect cognitive task performance, such as practice and learning. One large-scale study with a healthy control group (to control for nonspecific effects of repeated testing) reported no significant effect of 8 weeks of antidepressant treatment with sertraline, venlafaxine, or escitalopram on standardized assessments of cognition.12 Taken together, this evidence suggests that traditional SSRI treatment may be insufficient to address the full spectrum of cognitive deficits in MDD.

The multimodal antidepressant vortioxetine appears to have a more direct effect on cognitive symptoms and is the only medicine indicated by the FDA for the treatment of cognition in depression. As well as inhibiting serotonin reuptake, vortioxetine directly modulates serotonin modulator activity (acting as an antagonist at 5-HT3A, 5-HT7, and 5-HT1D receptors, a partial agonist at 5-HT1B receptors, and a full agonist at 5-HT1A receptors). Clinical trials have demonstrated vortioxetine’s ability to improve executive function and learning and memory, with particularly well-replicated effects on the Digit Symbol Substitution Test (a general measure of cognitive impairment that is not specific to any one cognitive domain).13,14 Importantly, path analyses suggest that vortioxetine’s cognitive benefits are, in part, independent of its antidepressant effects, suggesting direct procognitive properties. The magnitude of these effects appears more robust than those observed with conventional SSRIs, although head-to-head comparisons have suggested that its clinical superiority in the treatment of cognitive symptoms is marginal at best.15,16

Beyond serotonin, there is some evidence that modulators of dopamine (eg, bupropion, modafinil), glutamate (eg, ketamine), and acetylcholine (eg, donepezil) may have some positive effects on cognition in individuals with depression, although the extent to which these effects are independent from broader symptomatic improvements is not clear.17

Future Treatment of Symptoms

The development of treatments that effectively target both mood and cognitive symptoms is now recognized as essential for achieving successful long-term remission and functional recovery in depression. More selective targeting of specific serotonin receptors may hold promise in the development of novel treatments. In particular, there is ongoing interest in the potential of selective agonists of the 5-HT1A and 5-HT4 and selective antagonists of the 5-HT6 and 5-HT7 receptors. While there is promising evidence of this potential from animal studies and healthy volunteer studies, clinical evidence is still sparse. There are also some promising novel treatment targets in the pipeline, but they have not yet been tested in placebo-controlled randomized clinical trials in patients, including creatine, α2-adrenergic receptor antagonists, glucagon-like peptide-1 agonists, GABAB receptor agonists, and histamine H3 receptor antagonists.17 Finally, there are a range of nonpharmacological approaches to the treatment of cognition that may hold utility as stand-alone or adjunctive treatment approaches, including neurostimulation (transcranial magnetic stimulation, transcranial direct-current stimulation), cognitive remediation, and physical exercise.18 With renewed interest in this area, and a growing recognition of cognition as a neurobiologically and clinically distinct feature of MDD, there is genuine potential for improving the treatment of cognitive impairment in depression in the future.

Dr Murphy is an associate professor in the Department of Psychiatry at the University of Oxford. Murphy has received consultancy fees from Zogenix, Sumitomo Dainippon Pharma, UCB Pharma, and Janssen Pharmaceuticals. She holds grant income from UCB Pharma, Janssen Pharmaceuticals, and ADM.

References

1. Conradi HJ, Ormel J, de Jonge P. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychol Med. 2011;41(6):1165-1174.

2. Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med. 2014;44(10):2029-2040.

3. Varghese S, Frey BN, Schneider MA, et al. Functional and cognitive impairment in the first episode of depression: a systematic review. Acta Psychiatr Scand. 2022;145(2):156-185.

4. Semkovska M, Quinlivan L, O’Grady T, et al. Cognitive function following a major depressive episode: a systematic review and meta-analysis. Lancet Psychiatry. 2019;6(10):851-861.

5. McClintock SM, Husain MM, Wisniewski SR, et al. Residual symptoms in depressed outpatients who respond by 50% but do not remit to antidepressant medication. J Clin Psychopharmacol. 2011;31(2):180-186.

6. Maeshima H, Baba H, Satomura E, et al. Residual memory impairment in remitted depression may be a predictive factor for recurrence. J Clin Psychiatry. 2016;77(2):247-251.

7. Knight MJ, Air T, Baune BT. The role of cognitive impairment in psychosocial functioning in remitted depression. J Affect Disord. 2018;235:129-134.

8. Knight MJ, Lyrtzis E, Baune BT. The association of cognitive deficits with mental and physical quality of life in major depressive disorder. Compr Psychiatry. 2020;97:152147.

9. Ahern E, White J, Slattery E. Change in cognitive function over the course of major depressive disorder: a systematic review and meta-analysis. Neuropsychol Rev. Published online February 5, 2024.

10. Baune BT, Renger L. Pharmacological and non-pharmacological interventions to improve cognitive dysfunction and functional ability in clinical depression – a systematic review. Psychiatry Res. 2014;219(1):25-50.

11. Keefe RSE, McClintock SM, Roth RM, et al. Cognitive effects of pharmacotherapy for major depressive disorder: a systematic review. J Clin Psychiatry. 2014;75(8):864-876.

12. Shilyansky C, Williams LM, Gyurak A, et al. Effect of antidepressant treatment on cognitive impairments associated with depression: a randomised longitudinal study. Lancet Psychiatry. 2016;3(5):425-435.

13. McIntyre RS, Lophaven S, Olsen CK. A randomized, double-blind, placebo-controlled study of vortioxetine on cognitive function in depressed adults. Int J Neuropsychopharmacol. 2014;17(10):1557-1567.

14. McIntyre RS, Florea I, Tonnoir B, et al. Efficacy of vortioxetine on cognitive functioning in working patients with major depressive disorder. J Clin Psychiatry. 2017;78(1):115-121.

15. Nierenberg AA, Loft H, Olsen CK. Treatment effects on residual cognitive symptoms among partially or fully remitted patients with major depressive disorder: a randomized, double-blinded, exploratory study with vortioxetine. J Affect Disord. 2019;250:35-42.

16. Vieta E, Sluth LB, Olsen CK. The effects of vortioxetine on cognitive dysfunction in patients with inadequate response to current antidepressants in major depressive disorder: a short-term, randomized, double-blind, exploratory study versus escitalopram. J Affect Disord. 2018;227:803-809.

17. Colwell MJ, Tagomori H, Chapman S, et al. Pharmacological targeting of cognitive impairment in depression: recent developments and challenges in human clinical research. Transl Psychiatry. 2022;12(1):484.

18. Pan Z, Park C, Brietzke E, et al. Cognitive impairment in major depressive disorder. CNS Spectr. 2019;24(1):22-29.

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Launching Into the Deep
November 6, 2024
by Jenni Lord

“... unless you turn and become like children, you will never enter the kingdom of heaven.” Matthew 18:3 (ESV)

Relaxing by our community pool, I noticed a little girl about 8 years old climbing on her daddy’s shoulders to launch off into the deep. They’d been doing this for a few minutes in my periphery, but I felt a stirring as I stopped to take in the details.  Three other children were jostling about, trying to get their turn. She paid them no attention. Her gaze was focused on her dad. From my vantage point, I saw zero hesitation and detected no fear. Pure delight radiated from her face at the special opportunity.  She clearly trusted her dad. She knew how to swim. And she’d done this before. She was unfazed by others crowding around.  Dad held her feet until she was steady, and then she launched with her whole body, fully committed. I wondered if part of her confidence came from knowing he was within reach. His gaze was upon her as she landed with a big splash before he turned to the next waiting child.  In an instant, the scene challenged me to my core.  I’d been facing a new launch of my own with trepidation.  For the majority of my career, I’d been focused on one area, using familiar skills. But the Lord was calling me into a space to learn a new craft. Acquiring fresh skills demands the sacrifice of time, energy and other ventures. The prospect was uncomfortable and, frankly, daunting.  My launch had stalled.  Maybe you can relate.  When we believe God is calling us onto a new path, it can be fraught with obstacles some of our own making.  Yet as Jesus says in our key verse, “Unless you turn and become like children, you will never enter the kingdom of heaven” (Matthew 18:3).

Maybe I’ve hesitated to climb up on the sure shoulders of a good Father who can launch me into the deep. He knows I can swim. This isn’t my first jump. We’ve done this together before. Just like the dad in the pool, He’ll hold my hands as I climb up, and He won’t let go of my feet before I’m ready. I sense His invitation to stop wading in the shallow, to instead climb up and go.  When we venture into the deep, we can know God’s eye is upon us. Like that little girl, we can climb and jump. Fear can be replaced with joyful anticipation of what lies ahead for us.  Isn’t that the way of His story?