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Cited by 73Electroconvulsive Therapy StudiesTreatment of Major DepressionTranscranial Magnetic Stimulation Studies

Short- and Long-term Cognitive Outcomes in Patients With Major Depression Treated With Electroconvulsive Therapy

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Vasavada, Megha M., Leaver, Amber M., Njau, Stephanie, Joshi, Shantanu H., Ercoli, Linda, Hellemann, Gerhard, Narr, Katherine L., Espinoza, Randall·2017·The Journal of ECT
DOI 10.1097/yct.0000000000000426PMC PMC5705261
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Abstract

Objectives: The risk of cognitive impairment is a concern for patients with major depressive disorder receiving electroconvulsive therapy (ECT). Here, we evaluate the acute, short-term and long-term effects of ECT on tests of processing speed, executive function, memory, and attention. Methods: Forty-four patients with major depressive disorder receiving ECT (61% right unilateral, 39% mixed right unilateral–bitemporal, left unilateral, and/or bitemporal lead placement) underwent a cognitive battery prior to ECT (T1), after 2 sessions (T2), and at the end of the index (T3). Thirty-two patients returned for a 6-month follow-up (T4). Thirty-three control subjects were assessed at 2 times approximately 4 weeks apart (C1 and C2). Results: At baseline, patients showed deficits in processing speed, executive function, and memory compared with control subjects. Including depression severity and lead placement covariates, linear mixed-model analysis showed significant improvement in only processing speed between T1 and T3 and between T1 and T4 in patients. An acute decline in attention and verbal memory was observed at T2, but performance returned to baseline levels at T3. Longitudinal cognitive outcomes did not differ in patients defined as ECT responders/nonresponders. Limitations: Episodic memory was not measured, and medications were not controlled between T3 and T4. Control subjects also showed improvements in processing speed, suggesting practice effects for some measures. Conclusions: In this naturalistic ECT treatment study, results show that the initiation of ECT may transiently affect memory and executive function, but cognition is largely unaffected during and after ECT. Whereas some functions might improve, others will at least remain stable up to 6 months following the ECT index.

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  • This study's findings of adverse cognitive effects after ECT matched other studies using similar neurocognitive measures, which found effects in complex visual scanning, cognitive flexibility, attention, and verbal learning and memory.

    “Our study findings of adverse cognitive effects after ECT were in line with other studies that have used similar neurocognitive measures (e.g., Trail Making Test, Hopkins Verbal Learning Test-Revised) and found adverse effects for cognitive domains such as complex visual scanning and cognitive flexibility, attention, and verbal learning and memory.[48][49][50]”

    From Magnetic seizure therapy is efficacious and well tolerated for treatment-resistant bipolar depression: An open-label clinical trial (2020) · cites this paper as [48]

    The Discussion (page not provided) reports a decline in delayed verbal memory after two ECT sessions and a transient decline in inhibition, both of which recovered by the end of treatment. The Results (page not provided) do not show adverse changes on the Trail Making measures of visual attention and cognitive flexibility; the paper therefore does not support the full list of adverse effects attributed to it. (LLM, conf=0.88)

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Research works printed but not linked: 4

  1. [3]Abrams R Electroconvulsive therapy 4th Oxford; New York Oxford Unversity Press 2002
  2. [38]Wechsler D Wechsler Adult Intelligence Scale- Forth Edition (WAIS-IV) Pearson Education, Inc San Antonio, TX 2008
  3. [41]Wechsler D Advanced Clinical Solutions for the WAIS-IV and WMS-IV (ACS) Pearson Education, Inc San Antonio, TX 2009
  4. [46]Tombaugh TN Rees L McIntyre N Normative data for the Trail Making Test. Personal communication cited in Spreen and Strauss A compendium of neuropsychological tests: Administration, norms and commentary 2 New York Oxford University Press 1998

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Authors
Vasavada, M. M., Leaver, A. M., Njau, S., Joshi, S. H., Ercoli, L., Hellemann, G., Narr, K. L., & Espinoza, R.
Affiliations
University of California, Los Angeles (US)
Corresponding author
  • Vasavada, Megha M.
  • Leaver, Amber M.
  • Njau, Stephanie
  • Joshi, Shantanu H.
  • Narr, Katherine L.
ORCID
Venue
The Journal of ECT
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017-12
Volume
33
Issue
4
Pages
278-285
ISSN
  • 1095-0680 (ISSN-L)
  • 1533-4112
DOI
10.1097/yct.0000000000000426
PMC
PMC5705261
OpenAlex
W2706345148
Cited by
73
References
53
Citations by year
2026: 4 · 2025: 9 · 2024: 8 · 2023: 8 · 2022: 11 · 2021: 11 · 2020: 12 · 2019: 5 · 2018: 4 · 2017: 1
FWCI
4.94
Type
journal article
Language
en
Open access
Locations
  • Journal of Ect (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Institute of Mental Health (R01MH092301, K24MH102743)
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, major depressive disorder, cognitive impairment, processing speed, executive function, verbal memory, attention, long-term cognitive outcomes
MeSH terms
Adult, Aged, Attention, Cognition, Depressive Disorder, Major, Major Depressive Disorder, Electroconvulsive Therapy, Female, Humans, Male, Memory, Middle Aged, Neuropsychological Tests, Psychiatric Status Rating Scales, Recurrence, Treatment Outcome, Executive Function

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