Cognitive training to improve memory in individuals undergoing electroconvulsive therapy: Negative findings

Abstract

Although electroconvulsive therapy (ECT) remains the most effective treatment for severe depression, some patients report persistent memory problems following ECT that impact their quality of life and their willingness to consent to further ECT. While cognitive training has been shown to improve memory performance in various conditions, this approach has never been applied to help patients regain their memory after ECT. In a double-blind study, we tested the efficacy of a new cognitive training program called Memory Training for ECT (Mem-ECT), specifically designed to target anterograde and retrograde memory that can be compromised following ECT. Fifty-nine patients with treatment-resistant depression scheduled to undergo ultra-brief right unilateral ECT were randomly assigned to either: (a) Mem-ECT, (b) active control comprised of nonspecific mental stimulation, or (c) treatment as usual. Participants were evaluated within one week prior to the start of ECT and then again within 2 weeks following the last ECT session. All three groups improved in global function, quality of life, depression, and self-reported memory abilities without significant group differences. While there was a decline in verbal delayed recall and mental status, there was no decline in general retrograde memory or autobiographical memory in any of the groups, with no significant memory or clinical benefit for the Mem-ECT or active control conditions compared to treatment as usual. While we report negative findings, these results continue to promote the much needed discussion on developing effective strategies to minimize the adverse memory side effects of ECT, in hopes it will make ECT a better and more easily tolerated treatment for patients with severe depression who need this therapeutic option.

Computerized Cognitive Training in People with Depression: A Systematic Review and Meta-analysis of Randomized Clinical Trials

“…Thirteen studies used an active control group, seven studies had a passive control group, two studies had two CCT arms, 48,54 one study had two active control groups 44 and one study had both active and passive control groups. 55 Overall risk of bias was assessed as low in seven studies, some concerns in five studies, high in nine studies and one study 55 had one comparison assessed as low and the other as high (eTable 6 in the Supplement).…”

What role for cognitive remediation in the treatment of depressive symptoms? A superiority and noninferiority meta‐analysis for clinicians

“…The literature displayed a wide heterogeneity of techniques concerning CR protocols (for a detailed description of the interventions, see Item ). Most studies employed CR techniques that were focused on cold cognition impairments, such as EF and PS, using a variety of computer‐assisted cognitive training programs (e.g., Rehacom, PSSCogRehab, X‐Cog, and Alcor) or more traditional paper‐and‐pencil approaches (Alvarez et al, 2008; Arean et al, 2016; Choi et al, 2017; Dehn et al, 2018; Elgamal et al, 2007; Fritze et al, 1988; Kootker et al, 2017; Morimoto et al, 2020, 2014; Motter et al, 2019; Naismith et al, 2011; Pratap et al, 2018; Segrave et al, 2014; Semkovska et al, 2015; Trapp et al, 2016). Five out of 22 studies used CR techniques that were focused on the modification of attention and/or interpretation of cognitive biases, being hot cognition impairments frequently observed in depressed individuals (Bibi et al, 2020; Blackwell et al, 2015; Duque & Vazquez, 2018; Iacoviello et al, 2014; Nejati et al, 2019).…”

“…One of the cited studies included treatment‐resistant patients only in the treatment group (Morimoto et al, 2014). Five studies featured inpatients (Choi et al, 2017; Dehn et al, 2018; Fritze et al, 1988; Semkovska et al, 2015; Trapp et al, 2016). One research focused on patients with past strokes (Kootker et al, 2017).…”

“…Most studies had ≥18 years of age as an inclusion criterion. Three studies were conducted with TRD patients (Choi et al, 2017;Morimoto et al, 2020Morimoto et al, , 2014. One of the cited studies included treatmentresistant patients only in the treatment group (Morimoto et al, 2014).…”

Cognitive remediation following electroconvulsive therapy in patients with treatment resistant depression: randomized controlled trial of an intervention for relapse prevention – study protocol

“…To date there is only one RCT targeting cognitive-side-effects after ECT by training specific cognitive functions. Choi et al (2017) conducted a double-blind study investigating the efficacy of a specific memory training targeting anterograde and retrograde memory reporting negative findings [ 50 ]. They attributed their null findings in part due to the progression of ECT techniques, such as ultra-brief pulse width and right unilateral (RUL) electrode placement, with a more favorable side-effect profile regarding cognition.…”