A randomized controlled trial comparing the memory effects of continuation electroconvulsive therapy versus continuation pharmacotherapy: results from the Consortium for Research in ECT (CORE) study.
OBJECTIVE
To compare the memory effects of continuation electroconvulsive therapy (C-ECT) versus continuation pharmacologic intervention (C-PHARM) at 12 and 24 weeks after completion of acute electroconvulsive therapy (ECT).


METHODS
Eighty-five patients with Structured Clinical Interview for DSM-IV-diagnosed unipolar major depressive disorder, enrolled in a multisite, randomized, parallel-design trial conducted at 5 academic medical centers from 1997 to 2004, who had remitted with an acute course of bilateral ECT and remained unrelapsed through 24 weeks of continuation therapy, were included in this analysis. They were randomly assigned to C-ECT (10 treatments) or nortriptyline plus lithium (monitored by serum blood levels) for 24 weeks. Objective neuropsychological measures of retrograde and anterograde memory and subjective assessment of memory were obtained at baseline, 12 weeks, and 24 weeks. The Rey Auditory-Verbal Learning Test and the Autobiographical Memory Interview were the primary outcome measures.


RESULTS
The C-PHARM group showed a greater group difference (P < .01) for baseline to 12-week change for the Autobiographical Memory Interview. No other memory measures showed group differences for change scores from baseline to 12 weeks. Groups showed no baseline to 24-week change-score differences on any of the memory measures. For both groups, 12-week objective anterograde memory scores (eg, Auditory-Verbal Learning Test percent retention P = .0001; Rey-Osterrieth Complex Figure or Taylor Figure percent retention P < .002) and 24-week subjective memory scores were significantly improved (Squire Subjective Memory Questionnaire P < .02) over baseline. This result reflects the apparent resolution of a presumed decrement in anterograde memory associated with acute ECT preceding this study.


CONCLUSIONS
The finding of no memory outcome differences between unrelapsed recipients of C-ECT and C-PHARM is consistent with clinical experience. Memory effects have only a small role in the choice between C-ECT and C-PHARM.
Smith
Glenn E
GE
Mayo Clinic, Department of Psychiatry and Psychology-W11, 200 First Street, SW, Rochester, MN 55905, USA. smitg@mayo.edu
Rasmussen
Keith G
KG
Cullum
C Munro
CM
Felmlee-Devine
M Donna
MD
Petrides
Georgios
G
Rummans
Teresa A
TA
Husain
Mustafa M
MM
Mueller
Martina
M
Bernstein
Hilary J
HJ
Knapp
Rebecca G
RG
O'Connor
M Kevin
MK
Fink
Max
M
Sampson
Shirlene
S
Bailine
Samuel H
SH
Kellner
Charles H
CH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000523:psychology; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008568:Memory / Q000187:drug effects*; D008875:Middle Aged; D009483:Neuropsychological Tests; D009661:Nortriptyline / Q000008:administration & dosage / Q000009:adverse effects*; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018020:Lithium Compounds; D009661:Nortriptyline