Electroconvulsive therapy in severe depression: Effect on cognition
Nikhil S Gupta, Nilesh M Naphade, Jyoti V Shetty
Introduction: Depression is the leading global cause of disability and approximately, 350 million people suffer from depression worldwide. Despite the availability of numerous psychopharmacological treatments, evidence indicates that only 60–70% of persons who tolerate antidepressants will respond to first-line drug therapy for major depressive disorder. Resistance to the antidepressant medication is the main indication for ECT. However, the use of ECT remains controversial due to concerns about temporary cognitive impairment in persons with depression who receive acute ECT. The present study was planned to evaluate the effectiveness of ECT in severe depression and its effect on cognition. Materials & Methods: A total of 30 consecutive patients diagnosed with Severe Depressive Episode as per International Classification of Diseases (ICD-10) Diagnostic Criteria for Research and satisfying the eligibility criteria were taken in the study after informed consent. ECT was administered as per prevailing guidelines by means of a medical model BPE – 2000 giving bidirectional square wave pulse at a frequency of 20-90Hz. Baseline evaluation by Hamilton Rating Scale for Depression and Mini-Mental State Exam (MMSE) for cognition was done one day prior to ECT treatment. Post-treatment evaluation was carried out at the end of ECT treatment and at one month after ECT treatment. Results: The mean age of the study subjects was 38.53 years with 66.7% females and 33.3% males. Significant improvement was seen in depressive symptoms after ECT treatment (p<0.05). Mean Hamilton score at baseline, immediately after ECT and at 1 month follow up were 40.03, 14.32 and 14.89 respectively (p<0.01 and p-0.19). Study participants already had memory difficulties prior to treatment with 63.3% and 10% having mild and moderate impairment respectively which did not change drastically post-treatment (p-0.48). At 1 month follow-up, participants reported a slight increase in memory problems (53.3% mild and 30% moderate impairment), but the difference was not significant (p-0.25). Mean MMSE scores at baseline, immediately after ECT and after 1 month were 22.27, 21.23 and 19.56 respectively (p-0.69; p-0.056) Conclusion: The observation made in present study strongly suggest the benefits of ECT in reducing and providing sustained relief from the acute symptoms of depression while sparing cognition in most cases. The study findings may assist health care providers and potential patients to take a more informed decisions about their care.