Electroconvulsive therapy with a memory reactivation intervention for post-traumatic stress disorder: A randomized controlled trial

• Published in: Brain stimulation 2021-05, Vol.14 (3), p.635-642
• Main Authors: Tang, Victor M., Trought, Kathleen, Gicas, Kristina M., Kozak, Mari, Josselyn, Sheena A., Daskalakis, Zafiris J., Blumberger, Daniel M., Voineskos, Daphne, Knyahnytska, Yuliya, Pasricha, Suvercha, Chung, Yuan, Zhou, Young, Isserles, Moshe, Wong, Albert H.C.
• Format: Article
• Language: English
• Subjects: Electroconvulsive therapy; Imagery; Memory; Post-traumatic stress disorder; Reconsolidation; Stress disorders
• ISSN: 1935-861X; 1876-4754
• DOI: 10.1016/j.brs.2021.03.015

Post-traumatic Stress Disorder (PTSD) often does not respond to available treatments. Memories are vulnerable to disruption during reconsolidation, and electroconvulsive therapy (ECT) has amnestic effects To test the use of ECT to disrupt the reconsolidation of traumatic memories as a potential treatment for PTSD Participants were adults from the civilian population and were referred for ECT treatment for severe depression with comorbid PTSD symptoms. Twenty-eight participants were randomly assigned to reactivation of a traumatic or non-traumatic memory using audio script driven imagery prior to each ECT treatment. Primary outcomes were change in scores on the Modified PTSD Symptom Scale - Self Report (MPSS-SR) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Secondary outcomes included a comparison of the change in heart rate while listening to the script Twenty-five female patients who completed a post-ECT assessment were included in the analysis. No significant group differences were found in the MPSS-SR or CAPS-5 scores from pre-ECT to post-ECT or 3-month follow-ups. However, both groups improved at post-ECT and 3-month follow up. Partial eta squared estimates of effect size showed large effect sizes for all outcomes (η2 > 0.13). Changes in heart rate were not significantly different between groups or over time ECT paired with pre-treatment traumatic memory reactivation was not more effective for treating PTSD symptoms than ECT with non-traumatic memory reactivation. While our primary hypothesis was not supported, our data provides further support for the efficacy of ECT for improving symptoms of PTSD with comorbid depression. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT04027452. NCT04027452. •Reactivated memories can be disrupted during reconsolidation and Electroconvulsive Therapy (ECT) has amnestic side effects.•Patients were randomized to reactivation of a traumatic memory vs. a non-traumatic memory prior to ECT for PTSD symptoms.•No significant group differences were found but both groups improved post-ECT and at 3 months follow up.•Future research should optimize ECT and reactivation parameters and patient selection for better outcomes.