However, cognitive side effects of ECT have been well documented. The pattern of cognitive declines generally consists of a brief period of confusion during recovery from anesthesia, along with declines in anterograde and retrograde memory and executive functioning (Lisanby, 2007; Semkovska & McLoughlin, 2010). While most cognitive difficulties typically resolve in the days to weeks after the last ECT treatment (Semkovska & McLoughlin, 2010), retrograde memory loss can persist (Lisanby, 2007). Predicting who will have significant or lasting cognitive changes following ECT is an important clinical question.
Predicting Retrograde Autobiographical Memory Changes Following Electroconvulsive Therapy: Relationships between Individual, Treatment, and Early Clinical Factors
Martin, DM, Galvez, V, & Loo, CK. (2015). International Journal of Neuropsychopharmacology. 18(12), 1-8. http://dx.doi.org/10.1093/ijnp/pyv067
Background: Loss of personal memories experienced prior to receiving electroconvulsive therapy is common and distressing and in some patients can persist for many months following treatment. Improved understanding of the relationships between individual patient factors, electroconvulsive therapy treatment factors, and clinical indicators measured early in the electroconvulsive therapy course may help clinicians minimize these side effects through better management of the electroconvulsive therapy treatment approach. In this study we examined the associations between the above factors for predicting retrograde autobiographical memory changes following electroconvulsive therapy.
Methods: Seventy-four depressed participants with major depressive disorder were administered electroconvulsive therapy 3 times per week using either a right unilateral or bitemporal electrode placement and brief or ultrabrief pulse width. Verbal fluency and retrograde autobiographical memory (assessed using the Columbia Autobiographical Memory Interview – Short Form) were tested at baseline and after the last electroconvulsive therapy treatment. Time to reorientation was measured immediately following the third and sixth electroconvulsive therapy treatments.
Results: Results confirmed the utility of measuring time to reorientation early during the electroconvulsive therapy treatment course as a predictor of greater retrograde amnesia and the importance of assessing baseline cognitive status for identifying patients at greater risk for developing later side effects. With increased number of electroconvulsive therapy treatments, older age was associated with increased time to reorientation. Consistency of verbal fluency performance was moderately correlated with change in Columbia Autobiographical Memory Interview – Short Form scores following right unilateral electroconvulsive therapy.
Conclusions: Electroconvulsive therapy treatment techniques associated with lesser cognitive side effects should be particularly considered for patients with lower baseline cognitive status or older age.
SANE Australia ECT podcast and Fact Sheethttps://www.sane.org/mental-health-and-illness/facts-and-guides/ect-electroconvulsive-therapy
West Virginia University Health Report with Dr. Rolly Sullivan, MD “Electroconvulsive Therapy – WVU Health Report”https://www.youtube.com/watch?v=_39JzW7W6Fk
American Psychiatric Association. (2010). Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 3rd edition. American Psychiatric Publishing, Incorporated. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
American Psychiatric Association. (2001). The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging: A Task Force Report of the American Psychiatric Association, 2nd ed. American Psychiatric Publishing, Incorporated. Excerpts available at:http://www.ect.org/resources/apa/
Lisanby SH. (2007). Electroconvulsive therapy for depression.New England Journal of Medicine, 357, 1939–1945.http://www.nejm.org/doi/full/10.1056/NEJMct075234
Sackeim HA, Prudic J, Nobler MS, Fitzsimons L, Lisanby SH, Payne N, Berman RM, Brakemeier E, Perera T, & Devanand, DP. (2008). Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy.Brain Stimulation, 1, 71–83. http://www.ncbi.nlm.nih.gov/pubmed/19756236
Semkovska M & McLoughlin DM (2010). Objective cognitive performance associated with electroconvulsive therapy for depression: A systematic review and meta-analysis. Biological Psychiatry, 68(6), 568-577. http://www.ncbi.nlm.nih.gov/pubmed/20673880
UK ECT Review Group. (2003). Efficacy and Safety of Electroconvulsive Therapy in Depressive Disorders: A Systematic Review and Meta-Analysis. The Lancet, 361, 799-808. http://dx.doi.org/10.1016/S0140-6736(03)12705-5
van den Broek W, de Lely A, Mulder P, Birkenhager T, & Bruijn J. (2004). Effect of antidepressant medication resistance on short-term response to electroconvulsive therapy. Journal of Clinical Psychopharmacology, 24, 400-403.http://www.ncbi.nlm.nih.gov/pubmed/?term=15232331