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Dr. Bob is Robert Hsiung, MD,
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Posted by katekite on August 1, 2002, at 21:57:00
This is just a series of abstracts regarding minimizing memory loss with ECT. My interpretation is at the top.
The newer strategies to lower memory loss and cognitive problems seem to be: avoiding blood pressure fluctuation during the treatments, consuming caffeine before each treatment (or phenylephrine like in daytime flu medicine), keeping cortisol as low as possible (get it checked before to make sure it is not high), fewer treatments per week (2 not 3, total number not as important). TRH (thyroid stimulation) also may minimize memory loss. In a study, that I did not include, in rats piracetam has protective effects but a different study in people did not find this.
Keep in mind these reports all specifically look for helping memory, not necessarily also maximizing anti-depressive effect or anything else. They are small studies so they could be wrong. If you are considering ECT be aware that some memory problem can be found in almost everyone though it often is negligible: it is less risky as far as memory and cognition goes in younger people and those who do not have heart disease. Some relevant percentage of people unfortunately have life altering cognitive or memory loss so the risk is not to be ignored (though the possible benefits may outweigh the risks). It can be extremely effective for depression relief and is regaining some limited popularity when drugs have repeatedly failed. One fairly small study I did not include showed no difference in suicide rate whether or not a person had been given ECT, so some aspects of efficacy are controversial.
If you might consider taking caffeine or phenylephrine be sure to talk it over with the docs. Be sure also to mention any herbal supplements or vitamins even if you have taken them for years. Avoid licorice before treatments.
--------Convuls Ther 1993;9(2):95-100 Related Articles, Books, LinkOut
Caffeine Pretreatment Enhances Clinical Efficacy and Reduces Cognitive Effects of Electroconvulsive Therapy.Calev A, Fink M, Petrides G, Francis A, Fochtmann L.
Department of Psychiatry and Behavioral Science, State University of New York, Stony Brook, New York, USA.
In an open clinical trial, depressed patients received age-dosed, brief-pulse electroconvulsive therapy (ECT) either with or without 500 mg i.v. caffeine sodium benzoate before each treatment. Caffeine-pretreated patients required fewer ECT treatments, and after three to four treatments, their Hamilton Depression Scale (HDS) scores were significantly lower. At the end of the ECT course, both groups reached the same reduction in HDS scores. Of five memory tests, one showed better performance at the end of the ECT course for the caffeine-pretreated compared with the non-caffeine-pretreated patients. The results argue that caffeine-modified ECT differs from unmodified ECT in speed of response and the effects on cognitive tests.
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Convuls Ther 1993;9(1):14-22 Related Articles, Books, LinkOut
Blood Pressure, Memory, and Electroconvulsive Therapy.Zervas IM, Calev A, Jandorf L, Fink M.
Department of Psychiatry and Behavioral Sciences, State University of New York, Stony Brook, New York, USA.
Blood pressure changes recorded during electroconvulsive therapy (ECT) in 23 psychiatric in-patients with major depressive disorders correlated with and predicted the degree of anterograde memory changes measured 48-72 h after ECT. The Randt memory test was the principal measure of memory change. A subgroup of older patients with cardiovascular illness received trimethaphan, a ganglionic blocker that impedes a hypertensive surge during the treatment. They did not differ in memory function from a younger subgroup that did not receive trimethaphan. Control of the hypertensive response in the older age group counterbalanced the additional memory dysfunction that was anticipated as a result of advanced age and cardiovascular pathology.
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Biol Psychiatry 2001 Sep 1;50(5):331-6 Related Articles, Books, LinkOut
Cortisol levels predict cognitive impairment induced by electroconvulsive therapy.Neylan TC, Canick JD, Hall SE, Reus VI, Sapolsky RM, Wolkowitz OM.
Department of Psychiatry, University of California, San Francisco, CA 94121, USA.
BACKGROUND: Elevated glucocorticoids may increase the vulnerability of the brain to the adverse effects of repeated seizures. This study tested the hypothesis that higher ambient cortisol levels would predict increased cognitive impairment in depressed patients subsequent to receiving electroconvulsive therapy (ECT) for major depression. METHODS: Sixteen subjects provided three samples of saliva the day before receiving unilateral nondominant ECT. Measures of mood, global cognitive functioning, attention, executive function, verbal and visuospatial memory, and visuospatial processing speed were obtained 1 day before the first ECT and 1 day after the sixth ECT treatment. The relationship between basal salivary cortisol obtained before the first ECT treatment and the change score of each cognitive measure after the sixth ECT treatment was examined and tested with Pearson correlation coefficients. RESULTS: Electroconvulsive therapy treatments delivered over 2 weeks resulted in a significant improvement in mood and a decline in most measures of cognitive performance. Elevated basal cortisol was associated with a greater decline in performance of executive function, visuospatial processing speed, and verbal memory. CONCLUSIONS: Although this study is limited by the small number of subjects and the high number of comparisons, all significant correlations were consistent with the hypothesis that elevated cortisol predicts a greater degree of ECT-induced cognitive impairment.
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1: J ECT 2000 Jun;16(2):97-109 Related Articles, Books, LinkOut
Balancing speed of response to ECT in major depression and adverse cognitive effects: role of treatment schedule.Shapira B, Tubi N, Lerer B.
Depression Unit, Herzog Hospital, Jerusalem, Israel.
Schedule of administration (number of ECT per week and total number of treatments in the course) is one of a number of factors that may significantly influence the degree of cognitive impairment induced by ECT. We examined the effect of twice (ECT x 2) versus three times weekly (ECT x 3) bilateral ECT on cognitive function, particularly memory, in patients with major depression. Two studies were conducted, both double blind and controlled by the administration of simulated ECT (anesthesia and muscle relaxant only with no electrical stimulation). The results of these studies showed that the antidepressant effect of the two schedules, when assessed at the end of the ECT course, was equal. Speed of response was significantly greater with ECT x 3 but this schedule induced more severe memory impairment, even when the number of ECT in the series was not significantly different between the two groups. These findings are in general accordance with other studies that were similar in design although not as rigorously controlled. They support the conclusion that ECT x 2 is the more appropriate schedule for regular clinical practice unless speed of response is an overriding concern. In an era when patients administered ECT tend to be older and are more likely to manifest cognitive impairment for other reasons, choice of schedule is of particular relevance along with other factors such as electrode placement and stimulus intensity that influence ECT-induced cognitive impairment.
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J ECT 1998 Dec;14(4):236-40 Related Articles, Books, LinkOut
Effects of TRH administration on orientation time and recall after ECT.Zervas IM, Pehlivanidis AA, Papakostas YG, Markianos M, Papadimitriou GN, Stefanis CN.
Department of Psychiatry, Athens University Medical School, Eginition Hospital, Greece.
We investigated the effect of thyrotropin-releasing hormone (TRH) on orientation time and recall, in nine depressed female inpatients undergoing electroconvulsive therapy (ECT). In a balanced order crossover design, an intravenous bolus of 0.4 mg TRH or placebo was administered 20 min before ECT in the first two sessions. Orientation time and retrograde and anterograde components of the memory dysfunction, immediately and 24 h later, were assessed. Administration of TRH did not influence orientation time, word recall, or immediate short story recall compared with placebo. We did find, however, an improvement in the number of short story items recalled after 24 h when patients were given TRH compared with placebo. This indicates that TRH may have a protective role against the specific negative effect of ECT on delayed recall.
Posted by cybercafe on August 2, 2002, at 3:01:45
In reply to minimizing ECT induced memory loss, posted by katekite on August 1, 2002, at 21:57:00
> The newer strategies to lower memory loss and cognitive problems seem to be: avoiding blood
... there is memory loss in unilateral? .. i thought that was usually just for the events around the procedure (i could do with forgetting that) and it was temporary...
.. and i was under the impression that cognitive problems only occurred in the past, when they didn't provide oxygen...
.. please clarify...
>popularity when drugs have repeatedly failed. One fairly small study I did not include showed no difference in suicide rate whether or not a person had been given ECT, so some aspects of efficacy are controversial.
hmmm... i imagine that the more severe suicidal cases are going to be the ones that are given ECT, whereas the mild non-emergency cases would be given meds... maybe this is a factor... or maybe it isn't? ...
... i also hear that suicide may be a sign the person is getting better (?) .... i wonder if these occurred during treatment or afterwards...
Posted by katekite on August 2, 2002, at 13:04:57
In reply to Re: minimizing ECT induced memory loss, posted by cybercafe on August 2, 2002, at 3:01:45
> ... there is memory loss in unilateral? .. i thought that was usually just for the events around the procedure (i could do with forgetting that) and it was temporary...
I understand unilateral is less effective than bilateral but don't recall where I read that. My information all pertained to bilateral.
Here's a thing on side effects from http://www.psych.org/public_info/ect~1.cfm
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Side Effects
Immediate side effects from ECT are rare except for headaches, muscle ache or soreness, nausea and confusion, usually occurring during the first few hours following the procedure. Over the course of ECT, it may be more difficult for patients to remember newly learned information, though this difficulty disappears over the days and weeks following completion of the ECT course. Some patients also report a partial loss of memory for events that occurred during the days, weeks, and months preceding ECT. While most of these memories typically return over a period of days to months following ECT, some patients have reported longer-lasting problems with recall of these memories. However, other individuals actually report improved memory ability following ECT, because of its ability to remove the amnesia that is sometimes associated with severe depression. The amount and duration of memory problems with ECT vary with the type of ECT that is used and are less a concern with unilateral ECT (where one side of the head is stimulated electrically) than with bilateral ECT.---------
> .. and i was under the impression that cognitive problems only occurred in the past, when they didn't provide oxygen...
>
> .. please clarify...No, all of these problems are still possible. Which doesn't mean they occur. They found that people who had ECT more recently were happier with the treatment than people who'd had it a long time ago, and hypothesized that maybe this was due to improvements in ECT.
>>
> hmmm... i imagine that the more severe suicidal cases are going to be the ones that are given ECT, whereas the mild non-emergency cases would be given meds... maybe this is a factor... or maybe it isn't? ...
>
Here is the paper I saw on suicide:Convuls Ther 1986;2(1):3-6 Related Articles, Books, LinkOut
Does Electroconvulsive Therapy Prevent Suicide?Milstein V, Small JG, Small IF, Green GE.
Larue D. Carter Memorial Hospital and Indiana University School of Medicine, Indianapolis, Indiana, USA.
To examine the issue of whether or not electroconvulsive therapy (ECT) protects against suicidal death, we followed a complete population of 1,494 adult hospitalized psychiatric patients for 5-7 years. During that time there were 76 deaths, of which 16 or 21% were by suicide. Cause of death was not significantly related to age, gender, or research diagnosis. Patients who committed suicide were more apt to have received ECT than those who died from other causes, but this difference was not significant. A control group of living patients matched for age, sex, and diagnosis had very similar exposures to ECT, which further indicates that ECT does not influence long-term survival. These findings combined with a close examination of the literature do not support the commonly held belief that ECT exerts long-range protective effects against suicide.
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That above study is small, though it appears large. While they followed a lot of people only 16 total committed suicide so any conclusion has to be questionable. But, I thought it was interesting enough to include.
I don't mean to dissuade anyone who needs ECT from getting it or scare anyone as to the side effects. More wanting to explore ways to reduce the risk of memory loss. Even if 1% of people have permanent memory defects, that's too many. It is really unclear to me still what per cent of people actually have memory defects or cognitive problems that are distressing as every researcher seems to have a different notion of what "mild" or "impairment" means to them. Some seem to weigh potential benefit against risks, while others report only risks, or benefits.
Kate
>
Posted by Dave1 on August 5, 2002, at 17:36:14
In reply to minimizing ECT induced memory loss, posted by katekite on August 1, 2002, at 21:57:00
HI,
I had some ECT treatments awhile ago and they really improved my mood. I experienced short term memory problems, but so what, it didn't bother me much especially since I was feeling better.
The hardest thing for me to deal with was waking up disoriented and confused. Switching to DIPRIVAN as the anesthetic greatly helped that as well as getting 2mg iv ativan to help waking up.There is a good article comparing the efficacy of bilateral vs unilateral in PUBMED.
Search for author SACKHEIM, and subject ECT.
Written around 1999 or 2000.Bye,
Dave
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