ECT improves general neurocognitive function in bipolar patients

By Eleanor McDermid, Senior medwireNews Reporter

A randomised trial shows that electroconvulsive therapy (ECT) improves overall neurocognition in patients with treatment-resistant bipolar depression.

However, ECT appeared to compromise autobiographical memory consistency, although the researchers caution that they had neither a mentally healthy control group nor normative autobiographical memory consistency data that could be directly compared with that in their patients.

“Thus, the clinical implications of the current finding of reduced autobiographical memory consistency remain uncertain”, they write in The Journal of Clinical Psychiatry.

The trial included 51 patients, 39 of whom completed both baseline and follow-up neurocognitive testing. During 6 weeks of treatment, the 19 patients assigned to receive ECT and the 20 patients assigned to receive pharmacotherapy both had significant improvements in their average MATRICS Consensus Cognitive Battery composite score, from 42.3 to 46.4 and from 39.2 to 41.9, respectively.

Patients assigned to ECT underwent three weekly sessions of right unilateral, brief-pulse treatment until remission (Montgomery-Åsberg Depression Rating Scale ≤12) or up to 6 weeks.

“There is an active ongoing debate about the neurocognitive side effects of ECT, but they have not been investigated by randomized studies, with the exception of continuation ECT”, observe Ute Kessler (Haukeland University Hospital, Bergen, Norway) and co-authors.

The improvements in both groups were significant for processing speed, attention/vigilance, working memory, verbal learning and reasoning, although not for visual learning. Furthermore, the changes correlated with declines in the severity of depression.

However, both groups had a significant reduction in autobiographical memory consistency over time, with scores on the Columbia University Autobiographical Memory Interview–Short Form falling from 55.2 to 40.3 in the ECT group and from 54.0 to 43.6 in the pharmacotherapy group. The change was significantly larger in the ECT than the pharmacotherapy group.

“The risk of this side effect has to be evaluated against the benefits of the possible symptomatic and functional recovery, but also against the alternative risk of the cognitive decline due to untreated depression, medications, and the consequences of treatment delay”, say Kessler et al.

“The clinical relevance of our finding of reduced autobiographical memory consistency will also depend on the persistency of the impairment.”

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