Introduction: Electroconvulsive therapy (ECT) is a scientifically recognized and highly effective treatment method for treatment-resistant depressive disorders. ECT-induced cognitive side effects are of particular interest, as neuropsychological deficits considerably contribute to long-term functional outcome. Methods: Fifty-three patients with a severe treatment-resistant unipolar depression participated in on average 11.7 ECT sessions (SD=2.1). Immediately before and after ECT, as well as on average 41 days (SD=7.3) after treatment, a detailed neuropsychological examination with a focus on attention, memory and executive function was performed, and clinical data were collected. Results: Both self-ratings and external ratings indicate a significant response of affective symptoms to ECT-treatment (t1), which largely persisted at the follow-up examination (t2). After ECT (t1), especially in language-semantics and verbal episodic memory, performance worsening was found, but these remitted at t2. Regression analysis revealed a predictive relationship between cognitive performance before ECT (t0) and the extent of cognitive changes shortly after ECT (t1). That is, the higher the cognitive performance before ECT, the more pronounced the cognitive side effects were likely to be. A clear discrepancy could be shown with respect to objective cognitive performance and subjective cognitive complaints, as well as for symptom severity and cognitive dysfunction. Conclusion: Our results confirm findings of previous studies, indicating that cognitive decline shortly after ECT in treatment-resistant patients with severe depression is generally temporary and tends to return to baseline or improve over time. Data also show that the validity of cognitive functioning based on self-ratings shortly after ECT-treatment must be queried.
Zellner et al. (Mon,) studied this question.