Autobiographical Memory and Electroconvulsive Therapy

Abstract

Retrograde amnesia for autobiographical information is the most critical side effect of ECT. Much, if not most, modern research demonstrating long-term autobiographical amnesia following ECT has used either the Columbia University Autobiographical Memory Interview (CUAMI) or the short form of this scale (CUAMI-SF). Semkovska and McLoughlin claimed that studies using these instruments should be dismissed and the findings ignored due to a lack of normative data, as well as concerns about the reliability and validity of these instruments. In this commentary, the development and use of these scales is reviewed. It is shown that Semkovska and McLoughlin’s critique is factually incorrect, as normative data were simultaneously collected in virtually all studies using these instruments. Furthermore, there is substantial evidence supporting the reliability and validity of these scales. Indeed, these instruments are the only neuropsychological tests repeatedly shown to covary with patient self-evaluations of ECT’s effects on memory, and have repeatedly demonstrated long-term differences in the magnitude of amnesia as a function of ECT technique. Findings with the CUAMI and CUAMI-SF provide key evidence regarding ECT’s cognitive side effect profile. It is inaccurate and inadvisable to continue to deny that ECT can exert long-term adverse effects in this domain.

Randomised controlled trial of ketamine augmentation of electroconvulsive therapy to improve neuropsychological and clinical outcomes in depression (Ketamine-ECT study)

“…5,7,25 However, differences in cognitive impairment associated with different electrode placements for brief-pulse ECT when optimised for efficacy appear absent or modest. 26,27 There have been recent claims for marked cognitive benefit from RUL ultra-brief-pulse ECT compared with both bilateral ultra-brief-pulse ECT and all types of brief-pulse ECT without sacrificing efficacy; 19,28 however, a recent meta-analysis of six studies, although confirming the cognitive advantage, found that it came at the price of lower efficacy than for bilateral brief-pulse ECT. 29 The role of glutamate in depression and the effects of electroconvulsive therapy…”

“…loss of autobiographical memories may also persist, 19 although not all studies find this. 20,21 In addition, the methodology of the assessment of autobiographical memory impairment has been questioned, complicating interpretation of these data.…”

“…The AMI-SF has been criticised as it does not allow for improvements to be detected, for its lack of normative data for the normal loss of consistency over time and for a lack of information about the independent effect of mood, 22 although it has been defended against these criticisms. 19 An alternative extended scoring method has been recently proposed that allows more details to be scored at baseline, with points given for all items recalled. 134 A decrease in the consistency of memory of about 20% over 6 months in healthy volunteers has been found with the extended scoring method.…”

Bitemporal Versus High-Dose Unilateral Twice-Weekly Electroconvulsive Therapy for Depression (EFFECT-Dep): A Pragmatic, Randomized, Non-Inferiority Trial

“…We selected this instrument to situate our trial within existing research evidence, as most previous trials used a variant of it (8,(11)(12)(13). However, it does not allow quantification of retrograde amnesia attributable directly to ECT even though it is sensitive in detecting differences between treatment allocations on autobiographical memory recall (6,7,34,35). Nevertheless, the present trial shows that high-dose unilateral ECT affects autobiographical memory less than bitemporal ECT.…”

Further improving the cognitive effect profile of electroconvulsive therapy (ECT): The case for studying carbamylated erythropoietin

“…However, its use has been limited by negative portrayals in the media, as well as concerns about cognitive adverse effects, the extent of which continues to be debated in the scientific literature [2][3][4]. ECT may cause temporary cognitive impairment in some patients, typically anterograde amnesia for 1-2 weeks after a course of treatment, and circumscribed retrograde amnesia.…”