A Conceptual Introduction to Cognitive Remediation for Memory Deficits Associated With Right Unilateral Electroconvulsive Therapy

Objective: Although electroconvulsive therapy (ECT) is a highly effective treatment for people with severe depression, many patients report that treatment-induced memory problems are the most disturbing and serious adverse effects, affecting quality of life after treatment and willingness to consent to further ECT sessions. To date, no intervention to mitigate these cognitive deficits has been developed. We introduce the methodology of a novel cognitive training program called Memory Training for ECT (Mem-ECT) that is based on cognitive training in seizure disorders. Mem-ECT is designed to help memories that are usually compromised after ECT to remain relatively preserved. Methods: We evaluated the feasibility of implementing Mem-ECT in 8 adult patients with a diagnosis of major depressive disorder who underwent right unilateral ECT. This open pilot trial assessed recruitment procedures and treatment feasibility such as patient's burden and compliance, exercise length, and how best to integrate treatment sessions around the patient's schedule before undergoing ECT. Results: We found Mem-ECT to be fairly well tolerated by depressed inpatients and easily implemented within ECT treatment services. Conclusion: We discuss issues for future development, including an ongoing treatment-masked controlled study we are conducting to test the efficacy of Mem-ECT. Developing a safe and effective behavioral strategy to minimize ECT's adverse effects on memory may make ECT a more easily tolerated treatment.