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Clinical Research

The Cognitive Effects of Electroconvulsive Therapy in Community Settings

Neuropsychopharmacology volume 32, pages 244254 (2007) | Download Citation

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Abstract

Despite ongoing controversy, there has never been a large-scale, prospective study of the cognitive effects of electroconvulsive therapy (ECT). We conducted a prospective, naturalistic, longitudinal study of clinical and cognitive outcomes in patients with major depression treated at seven facilities in the New York City metropolitan area. Of 751 patients referred for ECT with a provisional diagnosis of a depressive disorder, 347 patients were eligible and participated in at least one post-ECT outcome evaluation. The primary outcome measures, Modified Mini-Mental State exam scores, delayed recall scores from the Buschke Selective Reminding Test, and retrograde amnesia scores from the Columbia University Autobiographical Memory Interview–SF (AMI–SF), were evaluated shortly following the ECT course and 6 months later. A substantial number of secondary cognitive measures were also administered. The seven sites differed significantly in cognitive outcomes both immediately and 6 months following ECT, even when controlling for patient characteristics. Electrical waveform and electrode placement had marked cognitive effects. Sine wave stimulation resulted in pronounced slowing of reaction time, both immediately and 6 months following ECT. Bilateral (BL) ECT resulted in more severe and persisting retrograde amnesia than right unilateral ECT. Advancing age, lower premorbid intellectual function, and female gender were associated with greater cognitive deficits. Thus, adverse cognitive effects were detected 6 months following the acute treatment course. Cognitive outcomes varied across treatment facilities and differences in ECT technique largely accounted for these differences. Sine wave stimulation and BL electrode placement resulted in more severe and persistent deficits.

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Acknowledgements

This work was supported in part by Grants R01 MH59069, R01 MH35636, R01 MH61609, and R01 MH05148 from the National Institute of Mental Health, Bethesda, MD, USA. We thank Dr Bernard Lerer for his comments on this work, and the staff at the seven hospitals who facilitated the conduct of this study.

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Affiliations

  1. Department of Biological Psychiatry, New York State Psychiatric Institute, New York, NY, USA

    • Harold A Sackeim
    •  & Joan Prudic
  2. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    • Harold A Sackeim
    • , Joan Prudic
    • , John Keilp
    •  & Mark Olfson
  3. Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    • Harold A Sackeim
  4. Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA

    • Rice Fuller
  5. Department of Neuroscience, New York State Psychiatric Institute, New York, NY, USA

    • John Keilp
  6. Department of Veterans Affairs Cooperative Studies Program and the Division of Biostatistics, Department of Health Research and Policy, Stanford University, Palo Alto, CA, USA

    • Philip W Lavori
  7. Department of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, New York, NY, USA

    • Mark Olfson

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Correspondence to Harold A Sackeim.

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DOI

https://doi.org/10.1038/sj.npp.1301180

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