Subjective Memory Immediately Following Electroconvulsive Therapy

Abstract

OBJECTIVES The aims of the present study were to describe the short-term rate of subjective memory worsening (SMW) and identify factors of importance for SMW in a large clinical sample treated for depression with electroconvulsive therapy (ECT). METHODS This register-based study included 1212 patients from the Swedish National Quality Register for ECT. Subjective memory worsening was defined as a 2-point worsening on the memory item of the Comprehensive Psychopathological Rating Scale from before to within 1 week after treatment. Associations between patient characteristics and treatment factors were examined using logistic regression. RESULTS Subjective memory worsening was experienced in 26%. It was more common in women than in men (31% vs 18%; P &lt; 0.001) and more common in patients aged 18 to 39 years than in patients 65 years or older (32% vs 22%; P = 0.008). Patients with less subjective memory disturbances before ECT had a greater risk of SMW. Patients in remission after ECT had a lower risk of SMW. A brief pulse width stimulus gave higher risk of SMW compared with ultrabrief pulse (odds ratio, 1.61; 95% confidence interval, 1.05-2.47). CONCLUSIONS Subjective memory worsening is reported by a minority of patients. However, young women are at risk of experiencing SMW. Ultrabrief pulse width stimulus could be considered for patients treated with unilateral electrode placement who experience SMW. Each patient should be monitored with regard to symptoms and adverse effects, and treatment should be adjusted on an individual basis to maximize the clinical effect and with efforts to minimize the cognitive adverse effects.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.<p>Funding agencies: Swedish Research Council [523-2013-2982]; Swedish Foundation for Strategic Research</p

Physician estimated vs. self-reported subjective memory in depressed patients treated with electroconvulsive therapy

“…Possibly CPRS-M-S is less well correlated to CPRS-M in this group. A recent study based on the Q-ECT data showed subjective memory worsening for 26% [13] compared to 20% (CPRS-M) and 27% (CRPS-M-S) in our study. Taking all this into account and bearing the limited sample size in mind, our study sample differs in some aspects from the Q-ECT and therefore does not fully represent the population in the Swedish Q-ECT.…”

“…The primary aim of this study was to analyze the consistency between self-reported and physician rated subjective memory in depressed patients before and after ECT treatment. This is important for the ability to compare self-ratings with previous reports using clinician's ratings [13]. The hypothesis of the study was that there is a high and significant consistency that supports using patients' self-reported subjective memory in clinical practice and in the Swedish Q-ECT.…”

Effects of Electroconvulsive Therapy on Depression and Its Potential Mechanism

“…According to a 17year retrospective study of 1571 ECT recipients, psychiatric individuals who received ECT had lower mortality than those who did not, though nested social and physical parameters affected the results (Liang et al, 2017), and another multistate observation study showed the effect of ECT in reducing shortterm readmission risk among those with server affective disorders (Slade et al, 2017). With respect to effects on memory, Brus et al (2017) used national register-based information to inquire about the rate of subjective memory worsening (SMW) reported with ECT, suggesting that patients who were female, young, less cognitively impaired before ECT, treatment-resistant, and experiencing wider pulse width were more likely to be subject to SMW, and their SMW reported rate was not low. However, this study had such limitations as significantly heterogeneous interference, subjective report collection, and the details of the ECT procedure.…”

“…However, cognitive decline was noted in some depressed patients who received ECT (Brus et al, 2017), and recovery from this declination was suggested to take half a year (Nuninga et al, 2018). However, whether ECT contributed more memory loss than pharmaceutical treatment is still in dispute, but the majority support the view of no additional cognitive damage ascribable to ECT than antidepressants (Husain et al, 2004;Kellner et al, 2016a,b;Bjoerke-Bertheussen et al, 2018).…”

“…However, whether ECT contributed more memory loss than pharmaceutical treatment is still in dispute, but the majority support the view of no additional cognitive damage ascribable to ECT than antidepressants (Husain et al, 2004;Kellner et al, 2016a,b;Bjoerke-Bertheussen et al, 2018). Moreover, less cognitive withdrawal was seen in unilateral to bilateral (Semkovska et al, 2016) and ultrabrief pulse to brief pulse (Loo et al, 2014;Brus et al, 2017;Martin et al, 2019) when the dosage was properly applied. Nonetheless, some studies found no dementia in individuals who underwent ECT (Osler et al, 2018), and in geriatric depressed patients, ECT even improved cognitive function (Socci et al, 2018).…”