This Interactive Learning Module examines the common co-occurrence of the symptoms of fatigue and cognitive compromise during the course of treatment of clinical depression. Dr. David Mischulon reviews the causes and differential diagnosis of co-occurrence at different time intervals during the treatment of depression, and presents studies that help guide management. The activity content also provides a review on the use of standardized instruments and how they support the rationale behind clinical decision making.

Learning Objectives

At the end of this educational activity, participants should be able to:

  • Understand the causes of fatigue that can complicate the treatment of clinical depression, including recognition of psychopharmacologic agents that contribute to asthenia.
  • Understand standardized instruments (CPFQ and HAM-D17) and how they help guide the management of clinical depression with a focus on physical wellbeing and cognitive impairment.
  • Examine psychopharmacologic agents that appropriate adjuvant agents to treat residual symptoms of fatigue and cognitive dysfunction.

Target Audience

Psychiatrists, psychologists, primary care/family physicians, nurses, and residents and fellows.


  • Director, Continuing Professional Development, Partners Healthcare
    Assistant Professor of Psychiatry, Harvard Medical School
  • Director of Research, Depression Clinical and Research Program, Massachusetts General Hospital
    Associate Professor of Psychiatry, Harvard Medical School

CME Information

Release Date: October 16, 2012
Latest Review:Tristan Gorrindo, MD, on October 2, 2014
Expiration Date: October 16, 2015

To receive credit for this activity, listen to the presentation and complete the post test and evaluation.

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of McLean Hospital and Massachusetts General Hospital. McLean Hospital is accredited by the ACCME to provide continuing medical education (CME) for physicians.

McLean Hospital designates this enduring material for a maximum of 1 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Credit Designation

Psychologists: The Massachusetts General Hospital Department of Psychiatry is approved by the American Psychological Association to sponsor continuing education for psychologists. The Massachusetts General Hospital Department of Psychiatry maintains responsibility for this program and its content. This offering meeting the criteria for 1 Continuing Education (CE) credit per presentation for psychologists.

Nurses: This program meets the requirements of the Massachusetts Board of Registration in Nursing (224 CMR 5.00) for 1 contact hour of nursing continuing education credit.

Policy on Faculty and Provider Disclosure

It is the policy of McLean Hospital that faculty and providers disclose real or apparent conflicts of interest relating to the topics of this educational activity. McLean Hospital has established policies in place that identify and resolve all conflicts of interest prior to this educational activity.

Planner Disclosures

The following planners of this activity have indicated that neither they nor their spouse/partner have a relevant financial relationship to disclose:

Robert J. Birnbaum, MD, reviewer
John A. Fromson, MD
Tristan Gorrindo, MD, reviewer
Anan Nathif, EdM

Speaker Disclosures

The following speakers of this activity have indicated that they or their spouse/partner have a relevant financial relationship to disclose:

David Mischoulon, MD, PhD
Research Support: Nordic Naturals, Ganeden, FisherWallace, Bowman Family Foundation
Speaking: Nordic Naturals, MGH Psychiatry Academy
Royalty: Lippincott Williams & Wilkins ("Natural Medications for Psychiatric Disorders: Considering the Alternatives," Mischoulon and Rosenbaum, Eds.)

Educational Support

  • Lilly
  • Dey
  • PamLab
  • Genomind

Hardware/Software Specifications

This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration

Flash Player: Adobe Flash Player 10.1+
Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+
Operating System: Windows XP+ or Mac OS X 10.4+
Internet Connection: 1 Mbps or higher

Minimum Requirements

Windows PC: 500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
Macintosh: Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit


This program has received support in the form of educational grants from the following companies: