What are the possible cognitive adverse effects of electroconvulsive therapy (ECT)?

Updated: Sep 24, 2019
  • Author: Mehul V Mankad, MD; Chief Editor: Dennis M Popeo, MD  more...
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Cognitive adverse effects are the major limitations to the use of ECT. [1] The most severe effects are observed postictally, with a brief period of disorientation and impairments in attention, praxis, and memory. [1] The effects reverse over time and are considered mild in most patients who experience them. [96]  Individual patients vary significantly in the extent and severity of cognitive adverse effects experienced after ECT. Most data support the conclusion that bilateral (specifically bitemporal) ECT is associated with greater frequency and severity of cognitive adverse effects than nondominant unilateral ECT. [1, 96]  Additional data supports the association between fewer cognitive adverse effects in patients receiving ultra-brief pulse ECT as compared to brief pulse ECT. [88]  Various biochemical, electrophysiological, and neuroimaging correlates of the cognitive adverse effects of ECT exist. [97]

Anterograde and retrograde amnesia may result from ECT. [1] After ECT, anterograde amnesia resolves rapidly. With retrograde amnesia, deficits are greatest for events closest to the time of treatment. [1, 63] Postictal delirium, exemplified by disorientation and confusion, may occur in a minority of patients. [1]  This form of delirium may be related in part to the ECT procedure or may be secondary to repeated episodes of general anesthesia. Use of dexmedetomidine or other agents to mitigate adverse effects of ECT may be effective but can also lengthen the anesthesia recovery period. [47]

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