3. Side Effects of ECT

A new early cognitive screening measure to detect cognitive side-effects of electroconvulsive therapy?. (2013) Martin D, Katalinic N, Ingram A et al.
http://dx.doi.org/10.1016/j.jpsychires.2013.08.021

This team from Australia constructed a cognitive screening battery of items from the MMSE and 3MSE together with some mental control items for use in this study of 123 inpatients treated with ECT at three different hospitals. The aim was to predict later cognitive side-effects as detected by a detailed cognitive battery that was also applied 1 – 3 days post completion of ECT. A combination of items from the screening battery were predictive of later changes in anterograde amnesia. These now need to collated and validated in a larger representative clinical population.

 

A double-blind, placebo-controlled study of the impact of galantamine on anterograde memory impairment during electroconvulsive therapy. (2013) Matthews JD, Siefert C, Blais MA et al. J of ECT; 29:170-178

Thirty nine inpatients were randomised to receive either galantamine or placebo during a course of ECT. Those in the galantamine group showed better retention of new information but there were many confounding variables relating to diagnosis, length of illness and treatment dose. The authors suggest further study.

 

Measuring retrograde autobiographical amnesia following electroconvulsive therapy. (2013). Semkovska M & McLoughlin D. J of ECT 29; 127-133

This review article describes autobiographical memory in health and depression and how normal autobiographical memory recall loses its consistency over the passage of time. This should be taken into account when measuring cognitive side effects at ECT. An assessment of the literature on retrograde autobiographical amnesia and ECT is presented. Inadequacies of published literature in this area may have implications for the registration of American ECT machines under new Food and Drink Administration (FDA) guidelines 2011. The authors suggest cognitive assessment tools and strategies for future research.

 

Retrograde amnesia after electroconvulsive therapy: a temporary effect? (2011). Meeter M, Murre J, Janssen S et al. J of Affective Disorders; 132, 216-222

A cohort of 21 patients were tested before and after ECT and again after 3 months using verbal learning (for anterograde impairment) and remote memory (for retrograde impairment) tests. Patient scores were lower than controls before and after ECT but memory for events in the months after ECT was as good as that of controls.

QT dispersion and rate-corrected QT dispersion during electroconvulsive therapy in elderly patients. (2011). Yamaguchi S, Nagao M, Ikeda T et al. J of ECT; 27:183-188.

The electrocardiographs of twenty older patients were compared to those of twenty younger patients before and after a course of ECT. Baseline rate corrected QT interval (QTc) was higher than normal limits before anaeasthesia and the rate corrected QT dispersion ( QTcD) was higher in the older group following treatment.

A conceptual introduction to cognitive remediation for memory deficits associated with right unilateral electroconvulsive therapy. (2011). Choi J,Lisanby S, Madalia A et al. J of ECT, 27: 286-291

The group found that the use of a memory training program was well received and easy to implement and suggest development to minimise the advers cognitive effects of ECT.

Unilateral brief-pulse electroconvulsive therapy and cognition: effects of electrode placement, stimulus dosage and time. (2010). Semkovska M, Keane D, Babalola et al. Journal of Psychiatric Research doi:10.1016/j.jpsychires.2010.11.001

This was a meta-analysis of cognitive side-effects after unilateral ECT relative to bitemporal electrode placement, dose of electricity and time interval between final treatment and cognitive testing. Thirty nine studies (1415 patients) were included. Differences in cognitive function were found in the first three days after final treatment. BECT and higher doses of UECT predicted greater cognitive impairment compared to lower dose UECT but these differences were not evident when patients were retested after three days. The authors conclude that the interval between the end of a course of ECT and cognitive testing is a more useful predictor of longer term function than electrode placement or dose of UECT above threshold.

Cognitive outcomes in electroconvulsive therapy: optimising current clinical practice and researching future strategies. March 2008. Colleen Loo. J of ECT, 24, 1-2.

An editorial introducing this edition of the Journal of ECT, which is entirely devoted to the cognitive effects treatment. Articles: outline the mechanisms of memory impairment, discuss what information patients should be given and describe techniques to minimise effect on cognitive function.

Cognitive side effects of brief pulse electroconvulsive therapy: a review. March 2008. Ingram A, Saling M, Schweitzer I, J of ECT, 24:3-9.

The authors outline results from studies of anterograde and retrograde memory impairment, describing patterns of recovery with the different types of ECT. The literature is sparse with regard to systematic studies of non memory cognitive function.

The effect of electroconvulsive therapy on autobiographical memory: s systematic review. March 2008. Fraser L, O’Carroll R, Ebmeier K, J of ECT; 24:10-17.

A review of 15 published studies confirming that autobiographical memory impairments are more common with sine wave vs brief pulse, bilateral vs unilateral treatment and high vs low dose and relate mainly to personal events in the six months prior to treatment. The studies did not account for subjective variation or control for level of depression.

Monitoring of cognitive effects during a course of electroconvulsive therapy: recommendations for clinical practice. March 2008. Porter R, Douglas K, Knight R, J of ECT; 24:25-34.

The authors suggest the routine use of a battery of tests to detect cognitive impairment at an early stage in order that steps can be taken to ameliorate cognitive side effects by changing treatment modality, dose, frequency of treatment etc. Also that the tests are repeated at 2 to 3 months post treatment along with a validated depression rating scale. Cognitive tests suggested are: 3MSE or MMSE, Hopkins verbal learning test, Autobiographical memory – short form, Digit symbol substitution task and Reorientation post treatment.

A dissociation between anterograde and retrograde amnesia after treatment with electroconvulsive therapy: a naturalistic investigation.  June 2008. O’Connor M et al. J of ECT; 24:146-151.

This group prospectively tested for retrograde amnesia of recently learned items and anterograde amnesia in two groups (22 individuals), one group receiving unilateral ECT and the other mixed unilateral and bilateral ECT, compared to 18 matched controls. They found no difference in the rate of retrograde amnesia detected between groups and no evidence of anterograde amnesia in either group.

Changes in everyday and semantic memory function after electroconvulsive therapy for unipolar depression. Schat et al. September 2007. J of ECT;23:153-157

Both types of memory were assessed in 96 patients before and after treatment and at 3 and 12 month follow-up. A small, reversible decrease in everyday memory function is influenced by age and electrode placement. Likewise influenced, semantic memory showed a fluctuating course towards recovery and a demonstrated improvement at follow up was greater in the older patients. However there were some longer lasting effects detected at 12 month follow up after bilateral ECT

The prevalence of prolonged cerebral seizures at the first treatment in a course of electroconvulsive therapy. Whittiker R, Scott A, Gardner M. March 2007. J of ECT; 23:11-13.

The group carried out EEG monitoring of 100 consecutive patients undergoing ECT. 95 EEGs were available for study. Two prolonged cerebral seizures lasting more than 120 seconds were detected (2%) (the UK definition of prolonged seizure is one lasting more that 120 seconds). One of those was associated with a prolonged motor seizure.

Subjective evaluation of the therapeutic and cognitive effects of ECT Berman et al. March 2007. Abstracts ACT/ISTS Scientific program. J of ECT; 23:56.

This was a prospective naturalistic study of 333 patients undergoing ECT for major depressive disorder who had completed pre and post treatment cognitive evaluation. Patient experience depended on assessment method. Direct questioning about global impact revealed more negative views; these were associated with objective measures of ECT’s effect on memory.

The cognitive effects of electroconvulsive therapy in community settings. Sackeim H et al. Neuropsychopharmacology (2007) 32, 244-254.

This was a large prospective study of 347 patients from 7 different centres. Cognitive testing was carried out before ECT, shortly after and again at 6 months post treatment. Most cognitive parameters were improved at 6 months follow up but for those that were not, differences in technique were more important than patient characteristics. Sine wave stimulation and bilateral electrode placement resulted in more severe and persistent deficits. There was no comparable non-ECT group

Electroconvulsive therapy, depression and cognitive outcomes. Fisher L et al. September 2004. J of ECT 20:174-178.

This was a one-year naturalistic study of 129 patients who received ECT compared to 843 patients otherwise treated for depressive disorder. Outcome scores used were the HoNOS and SF-36. The authors report no differences between groups by discharge despite the fact that the ECT group were significantly more depressed on admission. The ECT group as a whole showed no deterioration in cognitive function at discharge; there was no discrimination between unilateral and bilateral electrode placement. The cognitive function of the non-ECT group improved.

The Relationship between changes in Learning and Memory after Right Unilateral Electroconvulsive Therapy. Frasca T, Iodice MS and Vaughn McCall W. Journal of ECT September 2003, 19(3):148-150.

The authors try to tease out differences between verbal and figural learning and memory immediately post ECT. Deficits in verbal scores are shown in both and increase (non significantly) with the dose above seizure threshold. There was no such deficit in figural scores.

Pattern of cognitive dysfunction in depressive patients during maintenance electroconvulsive therapy. Rami-Gonzalez L et al. Psychological Medicine, 2003, vol 33, 345-350.

A group of eleven patients receiving maintenance ECT were matched for age sex etc. and both groups underwent a battery of tests including memory, attention and frontal function tests. The authors concluded that depressed patients preserve long term memory but suffer short term memory impairment and frontal function alteration during maintenance ECT.

Impact of maintenance ECT on concentration and memory.Datto C et al. Journal of ECT. September 2001, 17(3): 170-174.

The authors recognise the increased use of outpatient ECT in Philadelphia and set out to evaluate the use of telephone assessments to detect cognitive side-effects following maintenance ECT. The numbers were small but the authors of this pilot study concluded that maintenance ECT was well tolerated and that telephone consultations could provide an effective way of post treatment evaluation of cognitive side-effects.

Subtypes of memory dysfunction associated with ECT: characteristics and neurobiological bases.Rami-Gonzalez L et al. June 2001.. J of ECT, 17(2):129-135.

This paper reviews the different types of memory problem associated with ECT from a neurological perspective.

Memory and ECT: from polarization to reconciliation.Editorial by Harold Sackeim June 2000.. Journal of ECT, vol 16(2), 87-96.

This editorial acknowledges that memory impairment after ECT is common and introduces the key unanswered questions that form the subject of the papers in this special issue of the journal.

Balancing speed of response to ECT in major depression and adverse cognitive effects: role of treatment schedule.Shapira et al. June 2000, J of ECT 16(2):97-109.

The results of two double blind studies concurring with the previous conclusion that twice weekly ECT is the most optimum schedule for routine clinical practice unless speed of response is an overriding concern.

Electrophysiological correlates of the adverse cognitive effects of electroconvulsive therapy.Sakeim H et al. June 2000, J of ECT 16(2):110-120.

Further evidence to support the observation that post-ictal disorientation is related to post-ECT retrograde amnesia. These may share a common mechanism detectable by EEG.

Subjective memory complaints: a review of patient self-assessment of memory after electroconvulsive therapy. Prudic J et al. June 2000, J of ECT 16(2):121-132.

This review article outlines the problems of relying on group effects when studying cognitive function but concludes that more recent studies indicate that subjective memory improves following ECT.

Electroconvulsive therapy and memory loss: a personal journey. Donahue A. June 2000, J of ECT 16(2):133-143.

A personal statement which acknowledges the benefits of treatment but describes the nature and impact of the persistent memory loss that has led the author to call for enhanced informed consent.

Herbal treatments for ECS-induced memory deficits: a review of research and a discussion on animal models.Andrade et al. June 2000, J of ECT 16(2):144-156.

A review of the animal research taking place in India looking for a herbal remedy to attenuate the cognitive effects of ECS (electroconvulsive shock)

Angst J, Angst K, Baruffol I, Meinherz-Surbeck (1992), ECT-induced and drug induced hypomania. Convulsive Therapy. Vol 8 (3):179-185.

Calev A, Gaudino EA, Squires NK et al. (1995), ECT and non-memory cognition: a review. Brit. J clin. Psychol. 34, 505-515.

Coleman EA, Sackeim HA, Prudic J, Devanand DP, McElhiney MC, Moody BJ (1996), Subjective memory complaints before and after electroconvulsive therapy. Biological Psychiatry 39:346-356.

Devanand DP, Dwork AJ, Hutchison ER et al. (1994), Does ECT alter brain structure? AM J Psychiatry 151: 957-70.

Frith CD, Stevens M, Johnstone EC et al. (1983), Effects of ECT and depression on various aspects of memory. Brit. J Psych. 142, 610-617.

Miller AR, Isenberg KE (1998), Reversible ischaemic neurological deficit after ECT. J ECT 14:42-48.

Sackeim HA, Ross FR, Hopkins N, Calev L, Devanand DP (1987), Subjective side effects acutely following ECT: associations with treatment modality and clinical response. Convulsive therapy, 3:100-110.

Scott AI, McCreadie RG (1999), Prolonged seizures detectable by electroencephalogram in electroconvulsive therapy.Brit. J Psych. 175:91-92 July.

Scott AI, Riddle W (1989), Status epilepticus after electroconvulsive therapy.Brit. J Psych. 155:119-21 July.

Sobin C, Sackeim HA, Prudic J et al. (1985), Predictors of retrograde amnesia following ECT.Aam J. Psychiatry, 152: 7, 995-1001.

Squire LR, Slater PC, Miller PL (1981). Retrograde amnesia and bilateral electroconvulsive therapy - long term follow up. Arch.Gen. Psych., 38, 89-95.

Steif BL, Sackeim HA, Portnoy S et al. (1986). Effects of depression and ECT on anterograde memory.Biol. Psychiatry, 21, 921-930.