Systematic Review of Cognitive Effects of Electroconvulsive Therapy in Late-Life Depression

Kumar, Sanjeev; Mulsant, Benoit H.; Liu, Angela Y.; Blumberger, Daniel M.; Daskalakis, Zafiris J.; Rajji, Tarek K.

doi:10.1016/j.jagp.2016.02.053

Cited by 61 publications

(58 citation statements)

References 81 publications

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“…Both retrograde and anterograde amnesia are reported during or briefly after the ECT treatment . However, cognitive functions often improve and even transcend pretreatment levels once ECT is finished . In a review of 84 studies, a wide range of cognitive side‐effects associated with ECT was evident within the first 3 days following completion of the therapy .…”

Section: Introductionmentioning

confidence: 99%

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Association between hippocampal volume change and change in memory following electroconvulsive therapy in late‐life depression

Laroy

Bouckaert

Vansteelandt

et al. 2019

Acta Psychiatr Scand

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Laroy M, Bouckaert F, Vansteelandt K, et al. Association between hippocampal volume change and change in memory following electroconvulsive therapy in late-life depression.Objective: Electroconvulsive therapy (ECT)-induced hippocampal volume change (HVC) has been repeatedly described in recent years. The similar time course of HVC and ECT-related cognitive effects suggest a relation, that is to date, understudied. This study investigates whether HVC following ECT predicts the change in memory performance six months after the end of the ECT treatment. Methods: Hippocampal volume (HV) was measured via high-resolution 3D T1weighted images in 88 patients with late-life depression, within 1 week before and after ECT. Memory performance was assessed before and six months after ECT. Multiple linear regression was used to examine whether change in memory performance could be predicted based on ECT-induced changes in HV. Results: Larger right absolute HVC predicts less pronounced improvement on the VAT (visual memory) in the whole sample. For the 8-Word Test (verbal memory), Category Fluency Test (semantic memory), and MMSE, the effect is only present in patients who switched from right unilateral to bitemporal stimulation after six ECT sessions. Absolute HVC in the left hemisphere was not significantly related to cognitive change. Conclusion: A larger absolute change in right HV during ECT is associated with less improvement in memory performance up to 6 months post-ECT.

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Section: Introductionmentioning

confidence: 99%

“…Despite the fact that most adverse cognitive effects seem to be transient , memory loss is still the main complaint in patients who had ECT. Therefore, it is desirable to gain more insight into the mechanisms of ECT‐related cognitive dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Association between hippocampal volume change and change in memory following electroconvulsive therapy in late‐life depression

Laroy

Bouckaert

Vansteelandt

et al. 2019

Acta Psychiatr Scand

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“…People who will benefit most from ECT are those with depression that is resistant to other treatments and for those at risk of serious harm because of psychotic depression, suicidal ideation, or severe malnutrition . Although cardiovascular and cognitive side effects can occur with older adults, deleterious effects of ECT in LLD are usually limited and transient, with better cognitive outcomes with unilateral ECT …”

Section: Practice Implications: Actions That Can Helpmentioning

confidence: 99%

“…46 Although cardiovascular and cognitive side effects can occur with older adults, deleterious effects of ECT in LLD are usually limited and transient, with better cognitive outcomes with unilateral ECT. 47 In one study, when elderly people with unipolar depression were treated twice weekly with right unilateral ECT, their cognition, psychomotor agitation, and psychomotor retardation improved significantly. 48 This improvement was attributed to a significant gray matter volume increase, which was most pronounced on the side receiving neurostimulation.…”

Section: Electroconvulsive Therapymentioning

confidence: 99%

Late life depression: nursing actions that can help

Melrose

2018

Perspect Psychiatr Care

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Purpose This article explains the symptoms of late life depression (LLD) and discusses evidence‐informed actions that nurses can implement to provide older adults with the help they need. Conclusions Recognizing and addressing depression in older adults can enhance quality of life. Practice Implications People with LLD may not appear sad or express feelings of depression. Instead, they demonstrate loss of interest, frailty, cognitive impairment, suicidal ideation, unexplained somatic complaints, and loneliness. Documenting symptoms, screening, and assessing suicidal ideation are essential. Positive outcomes are associated with antidepressant medications, cognitive behavioral therapy, electroconvulsive therapy, neuromodulation therapies, and exercise.

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“…The PRIDE study also confirms that ultrabrief pulse right unilateral ECT, which may have fewer effects on cognition, elicits seizures effectively and sufficiently above the seizure threshold to produce clinical benefit in an older group of patients. This is important because geriatric patients often have difficult-to-treat depression, sometimes have baseline cognitive impairment, and may be more likely to develop cognitive side effects with ECT (9). The tolerability of continuation ECT plus medication is also noteworthy because the medication treatment arm includes lithium.…”

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confidence: 99%

Evidence for the Continuing Benefits of Electroconvulsive Therapy

Fochtmann

2016

AJP

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Electroconvulsive therapy has been an important part of the psychiatric armamentarium for over 75 years. Although ECT is most often used as a treatment for depression, its benefits have also been demonstrated in patients of all ages with catatonia, mania, and, under some circumstances, schizophrenia and schizoaffective disorder (1). Early in its history, ECT was the only available somatic treatment that was effective for severe psychiatric illness. However, with older techniques for ECT administration, side effects (including effects on cognition) were common. With the advent of psychotropic agents and concerns about ECT tolerability, its use became less frequent. Negative media portrayals fueled stigma about ECT and added to controversies about appropriate use. Despite all this, ECT remains our "go to" treatmentthe approach that clinical studies and experience tell us is most likely to elicit a rapid and robust response, even with severe symptoms that have not responded to other interventions.As with virtually all treatments in medicine, there are aspects of ECT that could be improved further. To maintain ECT benefits while minimizing cognitive effects, active foci of investigation have included new approaches: changing stimulus parameters, modifying electrode placements, prescribing adjunctive medications, or administering psychotherapy. Another challenging aspect of ECT practice is helping individuals remain well once ECT has exerted a salutary effort. Studies have shown that treatment with lithium in combination with nortriptyline after an index course of ECT can reduce relapse rates compared with placebo (2). Other research shows lithium plus venlafaxine (3) or continuation ECT alone (4) to have relapse rates comparable to those for lithium plus nortriptyline. Even with these approaches, a substantial number of individuals will still have recurrent symptoms within 6 months of an acute ECT course. The articles by Kellner et al. (5,6) in this issue of the Journal examine whether continuation ECT in combination with medication can maintain the acute antidepressant effects of ECT with acceptable tolerability and greater efficacy than continuation medication treatment alone.In phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study (5), patients age 60 or older with unipolar depression received venlafaxine (in dosages of up to 225 mg/day) in combination with three-times-a-week right unilateral ultrabrief pulse ECT at a stimulus dose of six times seizure threshold. Of the 240 patients who began phase 1, remission was achieved in 61.8%, 28.3% did not complete the trial, and 10.0% were nonremitters. This remission rate was about twice that for antidepressants in comparable populations, although it was slightly lower than rates in previous studies that used brief pulse ECT. Also, compared with studies of antidepressants, ECT trials typically enroll patients with more severe symptoms (7), and phase 1 of the PRIDE trial was no exception. The mean Clinical Global Impressions severity score was in the "ma...

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Systematic Review of Cognitive Effects of Electroconvulsive Therapy in Late-Life Depression

Cited by 61 publications

References 81 publications

Association between hippocampal volume change and change in memory following electroconvulsive therapy in late‐life depression

Association between hippocampal volume change and change in memory following electroconvulsive therapy in late‐life depression

Late life depression: nursing actions that can help

Evidence for the Continuing Benefits of Electroconvulsive Therapy

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