In addition to the cognitive deficits during acute and remitted stages of major depression, deficits in psychosocial and overall functioning in MDD are well recognized and of clinical importance. A prospective study found that patients with MDD or bipolar depressive episodes had moderate to severe impairments in work and home functioning as well as mildly to moderately impaired relational functioning (31). While evidence on the direct relationship between cognitive dysfunction and general functioning is emerging, some first evidence suggests that persistent cognitive deficits in depression may play an important role in patients’ ability to fully recover functionally over time (29, 32). If patients fail to return to work, poor cognitive function may be part of this failure as indicated by a study that showed that only cognitively recovered patients were able to return to work (6). Furthermore, a preliminary study suggests that deficits in executive functioning exert a mediating effect on the relationship between depression and impaired activities of daily living (33). A recently published systematic review confirms the relevance of cognitive function in day-to-day functional activities in MDD (34).
