Cognitive Performance Under Electroconvulsive Therapy (ECT) in ECT-Naive Treatment-Resistant Patients With Major Depressive Disorder

Ziegelmayer, Christoph; Hajak, Göran; Bauer, Anne M.; Held, Marion; Rupprecht, Rainer; Trapp, Wolfgang

doi:10.1097/yct.0000000000000385

Cited by 12 publications

(9 citation statements)

References 26 publications

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“…For delayed verbal recall, the overall lack of significant change between baseline and 4-month follow-up also masked an improvement in remitters compared with no change in those still depressed. Previous studies predominantly report no overall improvement in anterograde verbal memory in the months after ECT similar to our results (Bosboom & Deijen, 2006 ; Mohn & Rund, 2016 ; Nuninga et al, 2018 ; Vasavada et al, 2017 ; Verwijk et al, 2014 ; Ziegelmayer et al, 2017 ), with one study finding an improvement (Bodnar et al, 2016 ), and another an improvement on one test and not in another (Obbels et al, 2018 ). Four studies examined a potential influence of mood and found no effect in contrast to our findings (Bosboom & Deijen, 2006 ; Nuninga et al, 2018 ; Vasavada et al, 2017 ; Ziegelmayer et al, 2017 ), but small sample sizes mean they lacked statistical power.…”

Section: Discussionsupporting

confidence: 92%

“…A systematic review found that the performance on many objective neuropsychological tests is transiently impaired by ECT but improves to baseline or better within a few weeks after completing treatment (Semkovska & McLoughlin, 2010 ). More recent follow-up studies of assessing cognition a few months after ECT have also been consistent in finding no evidence of worsening, with some domains improving, compared with before ECT although the results conflict about which aspects of cognition show improvement (Bodnar et al, 2016 ; Bosboom & Deijen, 2006 ; Mohn & Rund, 2016 ; Nuninga et al, 2018 ; Obbels et al, 2018 ; Vasavada et al, 2017 ; Verwijk et al, 2014 ; Ziegelmayer et al, 2017 ). A remaining area of uncertainty however is whether or not past memories, especially autobiographical memory, might be adversely affected by ECT given the lack of evidence (Semkovska & McLoughlin, 2010 ) and methodological difficulties in the current assessment tools (Semkovska & McLoughlin, 2013 ).…”

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confidence: 91%

“…A systematic review of subjective memory after ECT reported the improvement following ECT correlated with improved depression, although there was considerable heterogeneity between studies (Vann & McCollum, 2019 ). In contrast, those investigating objective tests of cognition have nearly all found no relationship between performance and mood (Bosboom & Deijen, 2006 ; Fernie, Bennett, Currie, Perrin, & Reid, 2014 ; Maric et al, 2016 ; Nuninga et al, 2018 ; Vasavada et al, 2017 ; Ziegelmayer et al, 2017 ). The reasons for this discrepancy are not known but it is recognised that subjective and objective measures of cognition often do not correlate (Finnegan & McLoughlin, 2019 ), and in addition, studies of cognitive test performance after ECT have been mostly statistically underpowered and only reported mood effects incidentally.…”

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confidence: 99%

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Cognitive function after electroconvulsive therapy for depression: relationship to clinical response

et al. 2020

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Background. As uncertainty remains about whether clinical response influences cognitive function after electroconvulsive therapy (ECT) for depression, we examined the effect of remission status on cognitive function in depressed patients 4 months after a course of ECT. Method. A secondary analysis was undertaken on participants completing a randomised controlled trial of ketamine augmentation of ECT for depression who were categorised by remission status (MADRS ⩽10 v. >10) 4 months after ECT. Cognition was assessed with self-rated memory and neuropsychological tests of anterograde verbal and visual memory, autobiographical memory, verbal fluency and working memory. Patients were assessed through the study, healthy controls on a single occasion, and compared using analysis of variance.Results. At 4-month follow-up, remitted patients (N = 18) had a mean MADRS depression score of 3.8 (95% CI 2.2-5.4) compared with 27.2 (23.0-31.5) in non-remitted patients (N = 19), with no significant baseline differences between the two groups. Patients were impaired on all cognitive measures at baseline. There was no deterioration, with some measures improving, 4-months after ECT, at which time remitted patients had significantly improved self-rated memory, anterograde verbal memory and category verbal fluency compared with those remaining depressed. Self-rated memory correlated with category fluency and autobiographical memory at follow-up. Conclusions. We found no evidence of persistent impairment of cognition after ECT. Achieving remission improved subjective memory and verbal memory recall, but other aspects of cognitive function were not influenced by remission status. Self-rated memory may be useful to monitor the effects of ECT on longer-term memory.

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Section: Discussionsupporting

confidence: 92%

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confidence: 91%

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confidence: 99%

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Cognitive function after electroconvulsive therapy for depression: relationship to clinical response

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“…At no point was there any deterioration of cognitive function compared to baseline. These findings correspond to those from other groups using different cognitive test batteries or with shorter follow-up intervals (Bodnar et al, 2016;Maric et al, 2016;Obbels et al, 2018;Semkowska and McLoughlin, 2010;Verwijk et al, 2012;Ziegelmayer et al, 2017).…”

Section: Introductionsupporting

confidence: 88%

Neurognitive function and symptom remission 2 years after ECT in major depressive disorders

Mohn

Rund

2019

Journal of Affective Disorders

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Background: There is a lack of knowledge of possible cognitive side effects of electroconvulsive therapy (ECT) beyond the first few months after treatment. We aim to describe cognitive effects and symptom remission 2 years after ECT in major depressive disorders. Method: Twenty-seven depression patients were assessed with the MATRICS Consensus Cognitive Battery (MCCB) and the Everyday Memory Questionnaire (EMQ) before and 2 years after ECT. Their scores were compared with those of healthy matches. Depression and remission status were assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS). Main statistical analyses were ANOVAs and linear mixed model tests. Results: At baseline, the patient group was significantly impaired on 7 of 10 cognitive tests compared to the control group. Two years later, this gap was reduced to impairment on 5 of 10 tests. Within the patient group, neurocognitive function either increased significantly from baseline to follow-up, or there was no change. Two years after ECT, 62.9% of the patients were in remission. Those in remission reported better subjective memory function, but displayed no different neuropsychological test results, compared to the non-remitters. Limitations: Major limitations were low sample size and lack of uniform ECT procedure. Conclusions: We found improved neurocognitive function 2 years after ECT. This effect occurred regardless of remission status, suggesting that ECT induces unique cognitive boosting processes.

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“…For example, as shown in Table 4, on the VAT A, one patient (7%) performed significantly worse, 11 patients (73%) remained stable and 3 (20%) patients performed significantly better. Several authors, although investigating individual differences during a shorter follow-up period (until 6 months post-ECT), have reported similar findings [23,[47][48][49]. At present, we know little about why some patients' cognitive function will improve and others' will decline after ECT.…”

Section: Discussionmentioning

confidence: 84%

Neurocognitive functioning after electroconvulsive therapy in late‐life depression: A 4‐year prospective study

Obbels

Vansteelandt

Bouckaert

et al. 2020

Acta Psychiatr Scand

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Objective Despite the proven efficacy and safety of ECT, there is still concern about the possible cognitive side effects of ECT in older patients. In this study, we aimed to characterize the long‐term cognitive effects of ECT in patients with late‐life depression (LLD) from before the start until 4 years after the index ECT course. Methods Fourty one patients aged 55 years and older with a unipolar depression, referred for ECT, were included. The neuropsychological test battery was assessed prior to ECT, 6 months, 1 year, 2 years, 3 years, and 4 years after the last ECT session. Results We did not find any statistically significant cognitive changes from before the start to 4 years after ending the ECT course. Although we could not detect cognitive changes at group level, we found clinically important differences on an individual level. Conclusion Cognitive performance in patients with LLD runs a stable course from before the start of ECT until 4 years after the index course. At an individual level, however, both cognitive decline and improvement can be witnessed. Older patients can tolerate ECT and most of them will not experience long‐term cognitive side effects.

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Cognitive Performance Under Electroconvulsive Therapy (ECT) in ECT-Naive Treatment-Resistant Patients With Major Depressive Disorder

Abstract: Although findings that ECT does not lead to longer lasting cognitive deficits caused by ECT were confirmed, our study adds evidence that previous results of a beneficial effect of ECT on cognition might be questioned.

Cited by 12 publications

References 26 publications

Cognitive function after electroconvulsive therapy for depression: relationship to clinical response

Cognitive function after electroconvulsive therapy for depression: relationship to clinical response

Neurognitive function and symptom remission 2 years after ECT in major depressive disorders

Neurocognitive functioning after electroconvulsive therapy in late‐life depression: A 4‐year prospective study

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