Emotional Memory Reactivation Prior to Electroconvulsive Therapy not Effective for Depression Patients

While electroconvulsive therapy (ECT) can be effective in treating depression, about half of patients treated with ECT do not benefit sufficiently with high rates of relapses. ECT sessions may also weaken reactivated memorials, but the effect of emotional memory retrieval on cognitive schemas is currently unknown.

A team, led by Dominique S. Scheepens, MD, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, assessed whether emotional memory retrieval just prior to receiving electroconvulsive therapy weakens underlying cognitive schemes, improves ECT effectiveness, increases ECT response, and reduces relapse rates.

In the multicenter randomized clinical trial, the investigators examined 72 patients at 3 hospitals in the Netherlands between 2014-2018. Each patient was randomized to receive either emotional memory reactivation or control memory reactivation interventions before each ECT session.

The team used the Hamilton Depression Rating Scale (HDRS [total score range: 0-52, with 0-7 indicating no depression and ≥24 indicating severe depression]) to measure symptoms of depression during and after ECT, with a 6-month follow-up period.

Included in the study were individuals between 18-70 years old with a primary diagnosis of unipolar major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) with an indication for ECT.

The investigators sought main outcomes of depression scores and relapse rates within 6 months, assessed with the HDRS and analyzed using logistic and linear multiple regression analyses.

A total of 66 patients with a mean age of 49.3 years old were included in the final analysis, with 32 in the EMR-ECT group and 34 in the CMR-ECT group.

The investigators found regardless of the memory intervention, 42.4% (n = 28) of patients responded (≥50% decrease of symptom severity on the HDRS).

For the patients who responded, 39.3% (n = 11) relapsed within 6 months and remission rates (CMR-ECT group, 29.4% [n = 10] vs EMR-ECT group, 25.0% [n = 8]; P = .58), mean (SD) HDRS scores after the ECT course (CMR-ECT group, 14.6 [8.6] vs EMR-ECT group, 14.9 [8.8]; P = .88), total mean (SD) number of required ECT sessions for response (CMR-ECT group, 14.9 [7.9] vs EMR-ECT group, 15.6 [7.3]; P = .39), and relapse rates (CMR-ECT group, 46.7% [7 of 15] vs EMR-ECT group, 30.8% [4 of 13]; P = .33) were not significantly altered by the intervention.

“Study findings suggest that the EMR-ECT intervention just before patient receipt of ECT for depression did not improve effectiveness, increase speed of response, or reduce relapse rates after the ECT course compared with patients receiving CMR-ECT,” the authors wrote.

The study, “Effectiveness of Emotional Memory Reactivation vs Control Memory Reactivation Before Electroconvulsive Therapy in Adult Patients With Depressive Disorder,” was published online in JAMA Psychiatry.