Long-term cognitive effects of electroconvulsive therapy in major depressive disorder: A systematic review and meta-analysis

• Published in: Psychiatry research 2024-01, Vol.331, p.115611-115611, Article 115611
• Main Authors: Guo, Qinghua, Wang, Yong, Guo, Libo, Li, Xueqi, Ma, Xiangyun, He, Xiaoxiao, Li, Jitao, Zhang, Xiao, Shang, Shaomei
• Format: Article
• Language: English
• Subjects: Cognition; Cognitive Dysfunction - etiology; Cognitive Dysfunction - therapy; Cognitive function; Depressive Disorder, Major - psychology; Depressive Disorder, Major - therapy; Electroconvulsive therapy; Electroconvulsive Therapy - adverse effects; Electroconvulsive Therapy - psychology; Executive Function; Humans; Major depressive disorder; Meta-analysis; Systematic review
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2023.115611

•Emphasized the revolutionary potential of ECCA for precise cognitive assessment post-ECT.•Revealed the long-term overall cognitive changes following ECT.•Explored the variations within different sub-dimensions of cognition.•Provided important evidence for clinical guidelines. Electroconvulsive therapy (ECT) is endorsed as a principal treatment approach for major depressive disorder (MDD) worldwide. Despite prior studies highlighting potential short-term cognitive deficits post-ECT, the debate regarding its long-term implications persists. This study endeavors to elucidate the reasons for this contention using an evidence-based approach. This investigation, meticulously aligned with PRISMA guidelines, was prospectively enlisted on PROSPERO (CRD42023439259). A comprehensive search was performed across various databases, including PubMed, Cochrane Library, Web of Science, Embase, SCOPUS, PsycINFO, CINAHL Plus, and OpenGrey. This review, traversing the literature from inception until June 2023, encapsulated 10 studies (five RCTs and five quasi-experimental studies) involving a cohort of 868 individuals diagnosed with major depressive disorder. The meta-analysis revealed that the persistent discourse on ECT-induced long-term cognitive impairment chiefly emanates from the inadequacies in the specificity and sensitivity of conventional assessment instruments. Conversely, subgroup analyses showed that cognitive impairment in ECT, as gauged by the nascent assessment tool, Electroconvulsive Therapy Cognitive Assessment (ECCA) (SMD = -0.94, 95 % CI [-1.33, -0.54], p