Electroconvulsive therapy (ECT) for depression is the only treatment that is usually stopped when the patient has recovered. After successful ECT antidepressants are prescribed to prevent relapse. Since the widespread use of antidepressant pharmacotherapy, the indication for Electroconvulsive therapy (ECT) is often a medication resistant depression. Patients usually were treated with several antidepressants before ECT. Even with medication treatment failure for depression ECT is still very efficacious.
Depressed patients with pharmacotherapy treatment failure may benefit from the prophylactic effect of the same (class of) drug during maintenance therapy after response to ECT. Some patients relapse during adequate treatment with antidepressants after successful ECT. These patients usually will have another ECT course after which maintenance ECT is an option when antidepressants before and after ECT have failed to prevent relapse.
Maintenance ECT is effective in preventing relapse and recurrence in patients who have shown an initial response to ECT. During manintenance ECT the frequency of treatments is lowered. During a course patients are usually treated twice or three times weekly. During m-ECT this frequency can be lowered to once every 4 weeks. ECT frequency is lowered in small steps, from once a week to once every fortnight. In the first four months the frequency is lowered any further than once every two weeks.
During the course of ECT the most important side effects retrograde- and anterograde amnesia. To my opinion these cognitive side-effects do not increase and even might decrease during m-ECT. Cognitive side-effects during m-ECT are hardly studied because of small sample size and lack of control group.
In a recent study 12 patients receiving maintenance ECT were tested before and 90 minutes after an ECT treatment. Twelve other patients were tested at arrival in the hospital and 90 minutes later before receiving their maintenance ECT. The experimental group, tested before and 90 minutes after ECT did not show significant learning, attention or frontal decline in the second assessment after the ECT session, in comparison with the control group. However their visuospatial ability was lower than it was in the control group after after the second assessment. ECT sessions may cause some acute, mild dysfunction of visuospatial function.
Limitations of this study
Small patients samples (12 in each group).
No long term memory assessment
From this study we can not state that there are no adverse cognitive effects after one m-ECT session. But a lower frequency of treatments with a longer interval between treatments is probably to long to increase cognitive side effects. m-ECT does not produce clinical significant adverse cognitive side effects in contrast to an acute course of ECT
This research agrees with my clinical impression, anyone another opinion?
Related posts on this blog
Cognitive side-effects of ECT in adolescents
Everyday memory not affected by ECT on the long term
Side-effects of ECT how do they work out
Sackeims letter to the editor about memory loss due to ECT
RAMI, L., GOTI, J., FERRER, J., MARCOS, T., SALAMERO, M., BERNARDO, M. (2008). Cognitive functions after only one ECT session: A controlled study. Psychiatry Research, 158(3), 389-394. DOI: 10.1016/j.psychres.2007.01.005
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Hi Dr Shock,
Interesting post. I am really interested in ECT and maintenance therapy as it may in the end be the only thing that helps me, but while I had a good experience before I fear the long-term outcome of having more ECT, or follow-up maintenance ECT.
Have you read this article:
http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/jpn/vol-32/issue-4/pdf/pg241.pdf
It suggests that people with Bipolar Disorder do have learning and cognitive deficits following ECT. Can you comment on the study and maybe post about it as I really didn’t understand the whole article. I am really curious as to how much it indicates BP depression might be different in terms of memory/learning problems after ECT.
Thanks,
…aqua
Dear Dr. Shock,
I have a question. Your headline states in boldface, “Maintenance ECT does not produce cognitive side effects.”
Then down in paragraph 4 you state, “During the course of ECT the most important side effects(are)retrograde-and anterograde amnesia. To my opinion these cognitive side-effects do not increase and even might decrease during m-ECT. Cognitive side-effects during m-ECT are hardly studied because of small sample size and lack of control group.”
So if cognitive side-effects during m-ECT are hardly studied, how can you state, and without equivocation, that maintenance ECT does not produce cognitive side effects?”
Oh, I get it. We just accept your opinion as a substitute for hard science.
But not to worry, we’ve been doing that with the APA for decades. And then if somebody like Harold Sackeim comes along 69 years later and shows that maintenance ECT does routinely exacerbate long term cognitive impairment, we can always say, “Gosh, you coulda fooled me.”
And never forget, ECT IS SAFE AND EFFECTIVE. If you doubt it, just ask the American Psychiatric Association and its 38,000 psychiatrists.
Have a good day, Dr. Shock.
I was looking at an abstract of something entitled “Long-term maintenance ECT: a retrospective review of efficacy and cognitive outcome” by Russell JC, et al., of the Mayo Clinic (J ECT Mar 19, 2003).
One sentence stated, “Little is known about the outcomes of long-term use (> 1 year) of maintenance ECT.” As a 1972 recipient of ECT who experienced significant long-term cognitive impairment, I would think that maintenance ECT exacerbates long-term cognitive impairment. I would also assmume that the practitioners of ECT are little concerned about the question, judging from the fact that it took from 1938 until 2007—69 years—for a large scale(347 subjects) prospective study (by APA Task Force on ECT member Dr. Harold Sackeim) to be done on the effect of ECT on cognitive impairment. Dr. Sackeim found, of course, that ECT “routine(ly)” causes ong term cogntive impairment.