Cognitive side-effects of electroconvulsive therapy: what are they, how to monitor them and what to tell patients

Richard J. Porter; Bernhard T. Baune; Grace Morris; Amber Hamilton; Darryl Bassett; Philip Boyce; Malcolm J. Hopwood; Roger Mulder; Gordon Parker; Ajeet B. Singh; Tim Outhred; Pritha Das; Gin S. Malhi

doi:10.1192/bjo.2020.17

BJPsych Open (May 2020)

Cognitive side-effects of electroconvulsive therapy: what are they, how to monitor them and what to tell patients

Richard J. Porter,
Bernhard T. Baune,
Grace Morris,
Amber Hamilton,
Darryl Bassett,
Philip Boyce,
Malcolm J. Hopwood,
Roger Mulder,
Gordon Parker,
Ajeet B. Singh,
Tim Outhred,
Pritha Das,
Gin S. Malhi

Affiliations

Richard J. Porter: ORCiD; Treatment Algorithm Group; and Department of Psychological Medicine, University of Otago – Christchurch, New Zealand
Bernhard T. Baune: Treatment Algorithm Group; and Department of Psychiatry, University of Melbourne, Australia
Grace Morris: ORCiD; Treatment Algorithm Group; Academic Department of Psychiatry, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
Amber Hamilton: Treatment Algorithm Group; Academic Department of Psychiatry, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
Darryl Bassett: Treatment Algorithm Group; and Private Practice in Psychiatry and Division of Psychiatry, the University of Western Australia, Australia
Philip Boyce: Treatment Algorithm Group; and Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Australia
Malcolm J. Hopwood: Treatment Algorithm Group; and Department of Psychiatry, University of Melbourne, Australia
Roger Mulder: Treatment Algorithm Group; and Department of Psychological Medicine, University of Otago – Christchurch, New Zealand
Gordon Parker: Treatment Algorithm Group; School of Psychiatry, University of New South Wales; andBlack Dog Institute, Australia
Ajeet B. Singh: Treatment Algorithm Group; and School of Medicine, IMPACT Strategic Research Centre, Deakin University, Australia
Tim Outhred: Treatment Algorithm Group; Academic Department of Psychiatry, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
Pritha Das: Treatment Algorithm Group; Academic Department of Psychiatry, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
Gin S. Malhi: ORCiD; Treatment Algorithm Group; Academic Department of Psychiatry, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney; and CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, Australia

DOI: https://doi.org/10.1192/bjo.2020.17
Journal volume & issue: Vol. 6

Abstract

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BackgroundElectroconvulsive therapy (ECT) is recommended in treatment guidelines as an efficacious therapy for treatment-resistant depression. However, it has been associated with loss of autobiographical memory and short-term reduction in new learning.AimsTo provide clinically useful guidelines to aid clinicians in informing patients regarding the cognitive side-effects of ECT and in monitoring these during a course of ECT, using complex data.MethodA Committee of clinical and academic experts from Australia and New Zealand met to the discuss the key issues pertaining to ECT and cognitive side-effects. Evidence regarding cognitive side-effects was reviewed, as was the limited evidence regarding how to monitor them. Both issues were supplemented by the clinical experience of the authors.ResultsMeta-analyses suggest that new learning is impaired immediately following ECT but that group mean scores return at least to baseline by 14 days after ECT. Other cognitive functions are generally unaffected. However, the finding of a mean score that is not reduced from baseline cannot be taken to indicate that impairment, particularly of new learning, cannot occur in individuals, particularly those who are at greater risk. Therefore, monitoring is still important. Evidence suggests that ECT does cause deficits in autobiographical memory. The evidence for schedules of testing to monitor cognitive side-effects is currently limited. We therefore make practical recommendations based on clinical experience.ConclusionsDespite modern ECT techniques, cognitive side-effects remain an important issue, although their nature and degree remains to be clarified fully. In these circumstances it is useful for clinicians to have guidance regarding what to tell patients and how to monitor these side-effects clinically.

Published in BJPsych Open

ISSN: 2056-4724 (Online)
Publisher: Cambridge University Press
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry: Neurology. Diseases of the nervous system: Psychiatry
Website: https://www.cambridge.org/core/journals/bjpsych-open

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