title: A double-blind, placebo-controlled study of the impact of galantamine on anterograde memory impairment during electroconvulsive therapy.
abstract: BACKGROUND
  Electroconvulsive therapy (ECT) continues to be an effective treatment option for patients who fail to respond to pharmacological interventions, are unable to tolerate medications, and show a suboptimal response to behavioral and psychotherapeutic treatments. However, risks for cognitive impairment may contribute to some patients' refusal of ECT.
  
  
  METHODS
  The present study examined galantamine as a pharmacological intervention to reduce cognitive adverse effects from ECT. Thirty-nine inpatients diagnosed with major depressive disorder; bipolar disorder, depressed type; or schizoaffective disorder, depressed type and admitted for ECT were randomized to galantamine or placebo. Study drugs were initiated 24 to 48 hours before starting ECT and continued throughout the course of ECT. A neuropsychological test battery was administered at baseline and 24 to 48 hours after completing a course of ECT treatments. Depression severity was monitored using the 17-item Hamilton Rating Scale for Depression and Clinical Global Impression Scale at baseline, weekly, and end point. Self-rated adverse effects were monitored weekly.
  
  
  RESULTS
  Thirty participants (12 patients in the galantamine group, 18 patients in the placebo group) had both pretreatment and posttreatment neuropsychological ratings. Those in the galantamine group scored significantly higher at discharge for delayed memory (t28 = 2.44, P < 0.05). Hierarchical regressions examined if treatment condition predicted changes in delayed memory scores from baseline to discharge. Inclusion of the treatment condition in the final model made a significant incremental improvement in prediction (ΔR = 0.12, F1,27 change = 4.65, P < 0.05; β = 0.37, t = 2.16, P < 0.05). Galantamine was well tolerated with no clinically significant bradycardia or prolonged paralysis when administered with ECT.
  
  
  CONCLUSIONS
  Galantamine may be protective against impairment in retention of new learning. Galantamine exhibited minimal adverse effects and was safe when administered during ECT. The present findings require replication by future researchers using larger samples before broad conclusions can be drawn.
authors.affiliation: Psychiatry Department, Massachusetts General Hospital, Boston, MA, USA. jmatthews@partners.org
authors.forename: John D
authors.initials: JD
authors.lastname: Matthews
authors.forename: Caleb J
authors.initials: CJ
authors.lastname: Siefert
authors.forename: Mark A
authors.initials: MA
authors.lastname: Blais
authors.forename: Lawrence T
authors.initials: LT
authors.lastname: Park
authors.forename: Caleb J
authors.initials: CJ
authors.lastname: Siefert
authors.forename: Charles A
authors.initials: CA
authors.lastname: Welch
authors.forename: Christina M
authors.initials: CM
authors.lastname: Dubois
authors.forename: Adrienne O
authors.initials: AO
authors.lastname: van Nieuwenhuizen
authors.forename: Kathryn O
authors.initials: KO
authors.lastname: Rooney
authors.forename: Rita C
authors.initials: RC
authors.lastname: Seabrook
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Durham
authors.forename: Heather C
authors.initials: HC
authors.lastname: Adams
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
mesh_terms: D000339:Affect / Q000502:physiology; D020324:Amnesia, Anterograde / Q000209:etiology* / Q000517:prevention & control*; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D005702:Galantamine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D018697:Nootropic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy
chemical_list: D018697:Nootropic Agents; D005702:Galantamine