title: The effect of electroconvulsive therapy on neurocognitive function in treatment-resistant bipolar disorder depression.
abstract: OBJECTIVE
  To compare the effects of right unilateral (RUL) electroconvulsive therapy (ECT) and algorithm-based pharmacologic treatment (APT) on neurocognitive function in treatment-resistant bipolar disorder depression.
  
  
  METHODS
  Inpatients with DSM-IV-TR-diagnosed, treatment-resistant bipolar depression, who were acutely admitted to 1 of the 7 clinical study centers in Norway, were recruited from May 2008 to April 2011 into a prospective, randomized controlled, 6-week acute treatment trial. General neurocognitive function was assessed with the MATRICS Consensus Cognitive Battery (MCCB), and retrograde memory for autobiographical events was assessed with the Autobiographical Memory Interview-Short Form (AMI-SF) before and shortly after (mean = 23.5 days) a trial with either RUL brief-pulse ECT (mean dose = 233.3 mC) or APT.
  
  
  RESULTS
  Seventy-three patients entered, and 39 (nECT = 19, nAPT = 20) completed. Both groups showed improvements in all MCCB domain scores, with no significant differences between the study groups (no interaction effect: F₁,₃₇ = 1.52, P = NS). Improvements in neurocognitive performance were significantly correlated with reductions in depression ratings posttreatment. The AMI-SF score was significantly lower (based on consistent answers from pre- to posttreatment) in the ECT group (72.9%) than in the APT group (80.8%, P = .025), indicating reduced consistency in autobiographical memory after ECT.
  
  
  CONCLUSIONS
  General neurocognitive function was unaffected by RUL brief-pulse ECT treatment and positively related to improved mood in bipolar depression. Autobiographical memory consistency was reduced in patients treated with ECT. The results suggest that ECT can be used in treatment-resistant bipolar depression without compromising general neurocognitive function. The clinical relevance of reduced autobiographical memory consistency in the ECT group requires further investigation.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00664976.
authors.affiliation: Division of Psychiatry, Clinic for Psychosomatic Medicine, Haukeland University Hospital, 5021 Bergen, Norway ute.kessler@helse-bergen.no.
authors.forename: Ute
authors.initials: U
authors.lastname: Kessler
authors.forename: Helle K
authors.initials: HK
authors.lastname: Schoeyen
authors.forename: Ole A
authors.initials: OA
authors.lastname: Andreassen
authors.forename: Geir E
authors.initials: GE
authors.lastname: Eide
authors.forename: Ulrik F
authors.initials: UF
authors.lastname: Malt
authors.forename: Ketil J
authors.initials: KJ
authors.lastname: Oedegaard
authors.forename: Gunnar
authors.initials: G
authors.lastname: Morken
authors.forename: Kjetil
authors.initials: K
authors.lastname: Sundet
authors.forename: Arne E
authors.initials: AE
authors.lastname: Vaaler
mesh_terms: D000328:Adult; D000465:Algorithms; D001714:Bipolar Disorder / Q000188:drug therapy / Q000628:therapy*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D061212:Memory, Episodic; D008875:Middle Aged; D016896:Treatment Outcome