Rivastigmine Treatment for the Prevention of Electroconvulsive Therapy–Induced Memory Deficits in Patients With Schizophrenia

Abstract

Electroconvulsive therapy (ECT) is an effective strategy in some treatment-resistant patients with schizophrenia. However, ECT is associated with cognitive adverse effects, most notably, memory loss. This study examined the effects of rivastigmine, a selective central nervous system acetylcholinesterase inhibitor, with benefits on cognition in Alzheimer disease, on memory performance in patients with schizophrenia treated with ECT. Thirty inpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision schizophrenia treated with ECT were coadministered rivastigmine (3-4.5 mg/d) or placebo in a prospective, randomized, double-blind, placebo-controlled trial (maximum period of 4 weeks). Over the ECT course, scores on the cognitive subscale of the Alzheimer's Disease Assessment in subjects receiving placebo showed no significant change, whereas subjects receiving rivastigmine displayed decreased cognitive subscale of the Alzheimer's Disease Assessment scores, indicating cognitive improvement (P < 0.05). Findings suggest possible involvement of the acetylcholinergic system in mediation of cognitive deficits after ECT and indicate possible beneficial effects of rivastigmine coadministration in minimizing some of these ECT-induced cognitive impairments.

Acetylcholinesterase inhibitors for electroconvulsive therapy‐induced cognitive side effects: a systematic review

“…Fourth, in 2012, Stryjer et al . conducted a randomized controlled trial in 30 schizophrenic patients with oral rivastigmine (Stryjer et al ., ). The average mean age was 29 years.…”

“…Characteristics and main outcomes of the five selected studies are presented in detail in Table 1. All selected studies had small sample sizes (ranging from n = 17 to n = 45) with a variety of study designs including one double-blind, placebo-controlled crossover study (Levin et al, 1987), one pilot study designed as a controlled clinical trial (Matthews et al, 2008), and three randomized placebo-controlled trials (Prakash et al, 2006;Stryjer et al, 2012;Matthews et al, 2013). Two studies were conducted by the same author: the pilot study (Matthews et al, 2008) was succeeded by a randomized, double-blind placebo-controlled trial (Matthews et al, 2013).…”

“…Patients in the treatment group had significant better scores on delayed memory and abstract reasoning. Fourth, in 2012, Stryjer et al conducted a randomized controlled trial in 30 schizophrenic patients with oral rivastigmine (Stryjer et al, 2012). The average mean age was 29 years.…”

“…Therefore, we concluded that the impact of acetylcholinesterase inhibitors on ECT parameters was limited. Next, two studies reported nonsignificant differences in number of ECT sessions between the treatment group and placebo group (Stryjer et al, 2012). Finally, two studies examined the effect of acetylcholinesterase inhibitors on depression treatment (Matthews et al, 2008, Matthews et al, 2013, but these results were also non-significant.…”

Role of the cholinesterase inhibitors in the treatment of schizophrenia

“…This finding suggests the possible involvement of the cholinergic system in the mediation of cognitive deficits following ECT and indicates a potentially beneficial effect for rivastigmine coadministration in minimizing some of these ECT-induced cognitive impairments in treatmentresistant schizophrenia [26]. Interestingly, donepezil was also found to be useful in the treatment of the cognitive deficits associated with maintenance ECT, although this was found in a case report relying on a small sample [27].…”