American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line treatment of major depression in patients with cognitive impairment?

1. Psychotherapy only

2. Supportive therapy

3. Pharmacotherapy, with or without psychotherapy

4. Natural remedies

The correct answer is: Pharmacotherapy, with or without psychotherapy

Pharmacotherapy, with or without psychotherapy, is considered the first-line treatment for major depression in patients with cognitive impairment due to several reasons. Major depressive disorder (MDD), even in patients with cognitive deficits, can significantly impair daily functioning and quality of life. Pharmacotherapy, particularly with antidepressants such as selective serotonin reuptake inhibitors (SSRIs), is well-established for its efficacy in treating the symptoms of depression. These medications can help improve mood, motivation, and overall functioning. In individuals with cognitive impairment, this pharmacological approach can be particularly important, as cognitive deficits may hinder the effectiveness of psychotherapy alone. While psychotherapy can have valuable benefits, it typically requires a level of cognitive function that may be compromised in these patients. Therefore, combining medication with supportive psychotherapy when possible can yield the best outcomes. Supportive therapy is helpful, but it often doesn't address the underlying biological aspects of depression effectively on its own. Natural remedies, while popular, lack robust evidence for their efficacy compared to established pharmacotherapy methods in the treatment of major depression. Thus, both the combined approach of pharmacotherapy and psychotherapy or the use of pharmacotherapy alone offers a comprehensive strategy that can cater to the complexities of treating major depression in patients with cognitive impairment.