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

J ECT. 2017 Jun;33(2):104-110. doi: 10.1097/YCT.0000000000000385.

Abstract

Objectives: Although electroconvulsive therapy (ECT) is considered a safe and highly effective treatment option for major depressive disorder, there are still some reservations with regard to possible adverse cognitive adverse effects. This is the case despite a large body of evidence showing that these deficits are transient and that there even seems to be a long-term improvement of cognitive functioning level. However, most data concerning cognitive adverse effects stem from studies using mixed samples of treatment-resistant and non-treatment-resistant as well as ECT-naive and non-ECT-naive subjects. Furthermore, neurocognitive measures might partly be sensitive to practice effects and improvements in depressive symptom level.

Methods: We examined neurocognitive performance in a sample of 20 treatment-resistant and ECT-naive subjects using repeatable neurocognitive tests, whereas changes in depressive symptom level were controlled. Cognitive functioning level was assessed before (baseline), 1 week, and 6 months (follow-up 1 and 2) after (12 to) 15 sessions of unilateral ECT treatment.

Results: No adverse cognitive effects were observed in any of the cognitive domains examined. Instead, a significant improvement in verbal working memory performance was found from baseline to follow-up 2. When changes in depressive symptom levels were controlled statistically, this improvement was no longer seen.

Conclusions: 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.

MeSH terms

  • Adult
  • Aged
  • Cognition*
  • Depressive Disorder, Major / psychology*
  • Depressive Disorder, Major / therapy*
  • Depressive Disorder, Treatment-Resistant / psychology*
  • Depressive Disorder, Treatment-Resistant / therapy*
  • Electroconvulsive Therapy / adverse effects*
  • Electroconvulsive Therapy / psychology*
  • Executive Function
  • Female
  • Humans
  • Male
  • Memory
  • Middle Aged
  • Neuropsychological Tests
  • Psychiatric Status Rating Scales
  • Psychomotor Performance
  • Treatment Outcome
  • Verbal Learning