Memory Training Program Shows Promise in Countering Memory Loss From ECT Treatment

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Joan Prudic, M.D.
Joan Prudic, M.D.

A promising pilot study of a program called Memory Training for ECT (Mem-ECT) designed to prevent or lessen the memory loss experienced by many people with depression who undergo electroconvulsive therapy (ECT) was conducted by NARSAD Independent Investigator Grantee Joan Prudic, M.D., and colleagues at Columbia University Medical Center.

While highly effective for treating severe depression in those for whom current antidepressant medications and psychotherapies fail to work, ECT can trigger cognitive difficulties in a high percentage of patients, primarily significant and often permanent memory loss. ECT-induced memory loss can cause patients to abandon needed ECT before completion; the fear of it can lead other patients to resist ECT treatment altogether. To date, no intervention to mitigate the cognitive deficits imposed by ECT has been developed. The purpose of this initial Mem-ECT trial, which involved eight patients with depression, was to assess recruitment procedures, patient response and compliance, length of exercises and how best to schedule treatment sessions.

Mem-ECT is based on a method to forestall memory loss in epilepsy patients that was developed and piloted by Jimmy Choi, Psy.D., a member of Dr. Prudic’s group and first author of the paper. Sarah H. Lisanby, M.D., a 1996 NARSAD Grantee formerly at Columbia and now chair of psychiatry at Duke University School of Medicine, also participated in the study.

The Mem-ECT program is comprised of seven training sessions, each lasting  around 20 to 30 minutes, and incorporates paper-and-pencil and computer-based training tasks. There are two pre-ECT memory training sessions and five sessions after the final ECT treatment. The preliminary sessions are designed to alert patients to and explain about possible memory difficulties associated with ECT, and to teach and provide practice for memory-saving strategies.

In Mem-ECT drill and practice exercises, points that are first awarded for producing the best memory strategy are subsequently changed to rewards for identifying the worst strategy, with lessons to show why such a strategy is inefficient. This approach, which the authors claim leads to a much quicker learning curve, is a relatively novel technique not commonly found in current cognitive training programs where the focus is usually on identifying only the correct or best strategy.

While the original memory training for epilepsy provided the same exercises for all patients, Mem-ECT is personalized to each patient to maximize efficiency. Training begins at a level of difficulty tailored to the patient’s baseline cognitive profile, and task difficulty is then modified according to the patient’s progress.

To follow up on their positive preliminary findings, Dr. Prudic and her colleagues will now conduct a larger Mem-ECT study, involving 32 patients in a randomized, controlled trial that will extend over a two-year period.

Article comments

My brother was treated twice with ECT to deal with his depression. He was very bright and had a position as an actuary for an insurance company. It was the only occupation he ever pursed and he was in his early 50"s. After facing the possiblity of a third session, he elected to take his own life. Can I say that the prospect of further memory loss drove his to this behavior, of course not.
But it does highlight the how critical the research by Dr. Prudic and her team is in helping patients sustain memory function.

My daughter has undergone ECT for nearly 2 yrs. and has experienced serious and disheartening memory loss. Is there a way she can benefit from your findings or those of other researches before your study is completed?

After 19 ECT treatments as part of the ongoing memory study, I not only have forgotten many things but still have no recollection after the facts have been pointed out to me. 3+ months later I don't remember getting visits or calls from anyone except during my final two weeks after ECT had ended. But the loss pre-dates the start of ECT considerably. This week I was standing inside my son's storage unit. I said I'd never been there before; he said I was the one who rented the unit, created the security code and arranged the contents. Months prior to my admission in March I attended a NAMI training session for support group facilitators upstate. Yet when I found correspondence from the director with program information my response was to lament missing the training. Then I found my certificate from NAMI. I spent 3 days in a location hours from home and it didn't even ring a bell to see his letter thanking me for my interest and confirming that I could have a private room. I also suffered cognitively. Some ability is coming back to me but I still think I left about 20 IQ points behind.... I know ECT has helped many people, but of those who participated in Dr. Prudic's study while I was there, all but one person deny any improvement. Maybe it's subtle and we just haven't noticed it. Who knows? Things are pretty scattered in my head and I mostly notice worsening of symptoms vs. improvement. However, although I have no idea if ECT has anything to do with this, I'm not feeling suicidal at the moment. Paradoxically, I feel worse emotionally and my functionality has suffered. Still, while suicidality is a constant companion, completion currently seems like a bridge too far.

I received ECT over a dozen times. Each time I was treated, my depression symptoms decreased. My memory would be severely effected for a day or two following the treatment. It has now been 4 months since my last treatment and I have noticed a significant decrease in my ability to remember all sorts of things. My IQ has to be lower than it once was. I used to be a straight A student on scholarship in a doctorate program at a well-respected university. Now I can't remember the plots in most books, movies, and TV shows. It doesn't matter if I read or saw them long before ECT, during the year of ECT treatment, or if I read the book yesterday. I can't really even read a book. If I read a few chapters, the next day I can not remember well enough to pick up where I left off. I remember very little of what I read the previous day. I do think my memory is slowly improving. However I feel like a different person. I feel like I sacrificed a huge chunk of who I am. It is very disheartening. Can this memory treatment help me?

The description written by Pearl is an exact description of my symptoms and my life. My name is Earl and 'Pearl' is a name I use for online comments when I prefer not to use my real name. It is entirely possible that I am the Pearl that wrote that description on October 26, 2013. However, I don't remember it. I don't remember ever coming to this website or reading any of this material. Total memory loss of events is so common that I think I probably did write the description but only 2 weeks later I don't remember it at all.

If anyone has any ideas for memory recovery please, please, please email me at earlbmj@gmail.com

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