Early effects of modern electroconvulsive therapy on subjective memory in patients with mania or depression

Abstract

Context:Although electroconvulsive therapy (ECT) is considered a very effective tool for the treatment of psychiatric diseases, memory disturbances are among the most important adverse effects.Aims:This study aimed to assess prospectively early subjective memory complaints in depressive and manic patients due to bilateral, brief-pulse ECT, at different stages of the treatment, compare the associations between psychiatric diagnosis, sociodemographic characteristics, and ECT characteristics.Settings and Design:This prospective study was done with patients undergoing ECT between November 2008 and April 2009 at a tertiary care psychiatry hospital of 2000 beds.Materials and Methods:A total of 140 patients, scheduled for ECT with a diagnosis of bipolar disorder (depressive or manic episode) or unipolar depression according to Diagnostic and Statistical Manual of Mental Disorders IV diagnostic criteria, were included in the study and invited to complete the Squire Subjective Memory Questionnaire (SSMQ) before ECT, after the first and third sessions and end of ECT treatment.Statistical Analysis:Mean values were compared with the Kruskal–Wallis test and comparison of the longitudinal data was performed with a nonparametric longitudinal data analysis method, F1_LD_F1 design.Results:SSMQ scores of the patients before ECT were zero. SSMQ scores showed a decrease after the first and third ECT sessions and before discharge, showing a memory disturbance after ECT and were significantly less severe in patients with mania in comparison to those with depression.Conclusions:These findings suggest an increasing degree of subjective memory complaints with bilateral brief-pulse ECT parallel to the increasing number of ECT sessions.

Subjective memory complaints after electroconvulsive therapy: systematic review

“…We found that 15 out of 16 studies reported that major depressive disorder in unipolar or bipolar depression was the indication for treatment in the majority of patients. One study reported 59.3% of their sample being treated for mania 12 . Two studies reported use in patients with schizophrenia and schizoaffective disorders, although it was unclear whether these patients were treated for their depressive or primary psychotic symptoms 13 , 14 …”

“…The most commonly used tool for measuring subjective memory change was the SSMQ, with eight studies using all or part of this scale 6 , 12 , 15 – 20 . This is an 18-item questionnaire assesses various aspects of subjective memory on a Likert scale from −4 (much worse) to +4 (much improved), providing a total score comparing current memory with a previous time point.…”

“…A comparison of studies using the Squire Subjective Memory Questionnaire (SSMQ). Studies used brief pulse unless stated otherwise 12 , 15 , 16 , 18 , 20 . ECT, Electroconvulsive Therapy.…”

“…A more recent study of 140 in-patients, 75% with bipolar depression, undergoing ECT found a significant negative correlation between number of treatments and deterioration in subjective memory score across diagnostic groups tested within days of treatment by the SSMQ 12 …”

Treatment of Acute Manic Episodes in Bipolar Disorder

“…Electroconvulsive therapy (ECT) is effective during manic episodes; however, because it is an invasive procedure and has negative side effects on memory ( 49 ), the indications are limited. Exuberant behaviour that needs to be controlled immediately, catatonic symptoms, resistance to current treatment and causes that limit the use of drugs such as pregnancy and old age are among the indications of ECT ( 50 , 51 ).…”