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6
Cognition
The most troublesome and feared adverse effect of electroconvulsive therapy
(ECT) is memory loss. In fact, ECT typically causes predictable, largely tem-
porary, memory loss and other cognitive effects that are generally not serious
and are very acceptable, given the substantial relief from serious depression that
most patients can expect from ECT (Semkovska and McLoughlin, 2010).
Modern ECT techniques have markedly reduced the effects on memory for
most patients.
An older, detailed review of the effects of ECT on memory function can be
found in the Annals of the New York Academy of Sciences (Squire, 1986). A
more recent, comprehensive reference is the special issue of the Journal of ECT
on cognition (Loo, 2008). For our purposes, we can summarize ECT’s effects on
memory and cognition as follows:
ECT affects memory/cognition in three ways. It causes:
1. An acute postictal confusional state,
2. Anterograde memory dysfunction (AMD),
3. Retrograde memory dysfunction (RMD).
Brain Stimulation in Psychiatry: ECT, DBS, TMS, and Other Modalities, Charles
H. Kellner. Published by Cambridge University Press. © Charles H. Kellner, 2012.
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80 Chapter 6: Electroconvulsive Therapy (ECT): Common Adverse Effects
should not be confused with the erroneous notion that ECT works by causing
patients to forget how depressed they were.
Occasionally, reports appear of persistent, severe memory loss after ECT
(Donahue, 2000). Such reports are often sensationalized by the media and anti-
psychiatry groups. Adverse cognitive outcomes are much less likely in the modern
age, with contemporary ECT techniques, than they were in the distant past.
Muscle Aches
Diffuse myalgias are most commonly seen after the first ECT session and then
subside following subsequent treatments. This symptom is likely due to muscle
fasciculations from succinylcholine. Typically, the myalgias are transient and
respond well to the same symptomatic treatment used for headaches. If myal-
gias persist after subsequent treatments and the patient’s muscular block is
adequate, the practitioner should consider lowering the succinylcholine dose
or, in rare situations, blocking fasciculations by pretreatment with a small dose
of a nondepolarizing muscle relaxant.
Nausea
A minority of patients are nauseated after ECT. This side effect may be related
to the anesthetic, the seizure itself, or air in the stomach from assisted ventila-
tion. When it is a regular occurrence, nausea may be treated with intravenous
ondansetron (Zofran) 4 mg, given shortly before the procedure. Ondansetron
may also be given IV or po after the treatment for persistent nausea. Drinking a
carbonated beverage, such as, ginger ale, is also often helpful.
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82 Chapter 6: Electroconvulsive Therapy (ECT): Common Adverse Effects
References
Abrams, R. 2002. Electroconvulsive Therapy. New York: Oxford University Press.
Donahue, A. B. 2000. Electroconvulsive therapy and memory loss: a personal journey.
J ECT, 16, 133–43.
Loo, C. 2008. Cognitive outcomes in electroconvulsive therapy: optimizing current
clinical practice and researching future strategies. J ECT, 24, 1–2.
Markowitz, J. S., Kellner, C. H., Devane, C. L., et al. 2001. Intranasal sumatriptan in post-
ECT headache: results of an open-label trial. J ECT, 17, 280–3.
Semkovska, M., & McLoughlin, D. M. 2010. Objective cognitive performance associated
with electroconvulsive therapy for depression: a systematic review and meta-
analysis. Biol Psychiatry, 68, 568–77.
Squire, L. R. 1986. Memory functions as affected by electroconvulsive therapy. Ann N Y
Acad Sci, 462, 307–14.