The cognitive effects of electroconvulsive therapy in community settings
Abstract
Despite ongoing controversy, there has never been a large-scale, prospective study of the cognitive effects of electroconvulsive therapy (ECT). We conducted a prospective, naturalistic, longitudinal study of clinical and cognitive outcomes in patients with major depression treated at seven facilities in the New York City metropolitan area. Of 751 patients referred for ECT with a provisional diagnosis of a depressive disorder, 347 patients were eligible and participated in at least one post-ECT outcome evaluation. The primary outcome measures, Modified Mini-Mental State exam scores, delayed recall scores from the Buschke Selective Reminding Test, and retrograde amnesia scores from the Columbia University Autobiographical Memory Interview-SF (AMI-SF), were evaluated shortly following the ECT course and 6 months later. A substantial number of secondary cognitive measures were also administered. The seven sites differed significantly in cognitive outcomes both immediately and 6 months following ECT, even when controlling for patient characteristics. Electrical waveform and electrode placement had marked cognitive effects. Sine wave stimulation resulted in pronounced slowing of reaction time, both immediately and 6 months following ECT. Bilateral (BL) ECT resulted in more severe and persisting retrograde amnesia than right unilateral ECT. Advancing age, lower premorbid intellectual function, and female gender were associated with greater cognitive deficits. Thus, adverse cognitive effects were detected 6 months following the acute treatment course. Cognitive outcomes varied across treatment facilities and differences in ECT technique largely accounted for these differences. Sine wave stimulation and BL electrode placement resulted in more severe and persistent deficits.
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ECT is associated with adverse cognitive effects that may limit treatment acceptability.
“However, ECT is associated with adverse cognitive effects that may limit treatment acceptability (McClintock et al., 2011;Sackeim et al., 2007;Semkovska and McLoughlin, 2010).”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Sackeim et al., 2007
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“Anterograde memory changes generally return to normal or may be improved compared to pre-ECT levels within 2–4 weeks (Semkovska and McLoughlin, 2010) but retrograde impairment, which is more likely with bitemporal placement, can persist for prolonged periods (Sackeim et al., 2007).”
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- Authors
- Sackeim, H. A., Prudic, J., Fuller, R., Keilp, J., Lavori, P. W., & Olfson, M.
- Affiliations
- New York State Psychiatric Institute (US)
- Rutgers, The State University of New Jersey (US)
- Stanford University (US)
- Venue
- Neuropsychopharmacology
- Published
- 2006-08-23
- Volume
- 32
- Issue
- 1
- Pages
- 244-254
- ISSN
- 0893-133X (ISSN-L)
- 1740-634X
- OpenAlex
- W2164409937
- Cited by
- 577
- References
- 3
- Citations by year
- 2026: 28 · 2025: 28 · 2024: 36 · 2023: 21 · 2022: 30 · 2021: 44 · 2020: 39 · 2019: 33 · 2018: 25 · 2017: 28 · 2016: 34 · 2015: 31 · 2014: 27 · 2013: 26 · 2012: 29
- FWCI
- 12.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Neuropsychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH035636, R01MH061609, R01 MH05148, R01MH059069)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Keywords
- electroconvulsive therapy, cognitive side effects, major depressive disorder, retrograde amnesia, delayed recall, reaction time, bilateral electrode placement, long-term cognitive outcomes, age and sex differences
- MeSH terms
- Adult, Aged, Analysis of Variance, Cognition, Major Depressive Disorder, Electroconvulsive Therapy, Female, Humans, Functional Laterality, Longitudinal Studies, Male, Memory, Middle Aged, Neuropsychological Tests, Prospective Studies, Psychiatric Status Rating Scales, Residence Characteristics, Treatment Outcome
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