The Cognitive Effects of Electroconvulsive Therapy: A Critical Review

In this article, we discuss the neurocognitive domains affected by electroconvulsive therapy (ECT), moderators of ECT-related cognitive change, and cognitive outcomes in high-risk populations, as well as compare the cognitive effects ECT to other common treatments for refractory depression. Despite ECT being one of the oldest and most common treatments for refractory depression, various approaches to ECT (ie, strength, wavelength, and electrode placement), use of clinical convenience samples, and employment of varied and often inadequate methods of neurocognitive assessment have contributed to ongoing confusion regarding the nature and severity of post-treatment cognitive side effects. Although findings suggest that most healthy adults return to neurocognitive baseline within a few days after treatment, older adults and those with premorbid neurological impairment may be at an increased risk of prolonged mental status changes post-ECT. Employment of comprehensive neuropsychological batteries versus screening measures may assist in further understanding the nature and course of post-treatment cognitive side effects.