Electroconvulsive Therapy in Severe Depression: Is Amnesia a Problem?
IOSR Journal of Dental and Medical Sciences
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 memory
... about memory impairment in persons with depression who receive acute ECT. The present study was planned toevaluate the effectiveness of ECT in severe depression and its effect on retrograde and anterograde amnesia or any change in their level due to ECT. 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 Depressionwhile Autobiographical Memory Interview (AMI) and Wechsler Memory Scale (WMS) -Third India Edition was used for assessment of retrograde and anterograde amnesia following ECT. 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). AMI scores were significantly lower at post-treatment (79.32 ± 17.93) and follow-up (76.76 ± 20.88) when compared to pre-treatment AMI scores (100 ± 0.00). A repeated measures ANOVA which compared mean scores for the immediate and delayed Logical Memory Test (WMS) across treatment did not demonstrate any significant effect for ECT. 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 no changes were observed in participants anterograde memory. However persistent problems with retrograde amnesia can be a cause of concern. The study findings may assist health care providers and potential patients to take a more informed decisions about their care.