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

I feel for those of you posting above. I am a male, late 40s and wen through several series of bilateral and unilateral ECT treatments at a prestigious medical center from 2008-2010. The treatments may have saved my life, but I now have many of the conditions noted above. I cannot recall any events from that time frame. I have issues with recalling peoples names and recalling words sometimes that are on "the tip of my tongue". I have had some improvement I think due to exercise, nutrition and mindfulness. There seem to be many emerging commercial programs that claim to have brain games and exercises to improve cognition, executive functioning and memory retrieval but most probably cannot support their claims with scientific evidence - or use flawed research to support their claims. New developments in neuroscience, brain imaging and alternative treatments keeps me hopeful for advancements in treatment. My friends and family are very, very supportive but I think there is still social stigma attached to ECT and mental illness in general. Keep the faith.

It has not been 10 months since my last ECT. The more time goes by the more that I notice is missing. I have posted twice on this site in the past. I want to give a brief update. Like KSM65 I am using mindfulness, commercial programs, exercise, and good nutrition. My ability to cope with and compensate for the losses is improving. However almost everyday I discover new things that I don't remember. Many of those things predate ECT by several years. I am much much less effective at relationship management. I can't remember important conversations I had with my wife yesterday. I remember having them, I remember that we went on a walk and had pleasant and valuable conversation that I wanted to remember but no matter how much I try I can not remember what we talked about. I am 37 but I feel like my brain is 92 and dementia is setting in.

Like many of the posters...I had 41 bilateral, unilateral and LART treatments for severe, and so far, untreatable depression and suicidal ideations. It has now been five months from my last treatment, my memory has been greatly impacted, my ability to read has been challenged and my ability to remember 'steps' is gone. B'and D's look the same to me as do 'g' and 'd'. Also, I cannot recall simply words in the middle of a sentence, likewise, when I write, although I know what I want to say, I miss words. Sadly, my depression remains. From treatment 1 to 12, I told my psychiatrist I'd take a bit of memory loss if I could feel better...and I should have stopped at #20. But the eternal of feeling even slight relief or hope kept me going.

I researched ECT for a year before choosing to start it so I did know this could happen, it is still sad and frustrating. Additionally, my hospital and clinic offers no follow up memory care or support, there are no ECT support groups in San Francisco, or anywhere for that matter, that I could find. A support group model would be easy to implement...and could help many people, both who saw success thru treatment, and for those of who didn.t.

I have had over 50 bilateral ECTs. I stopped that treatment 3yrs ago because of severe memory damage. I forgot every street in the city I have lived in for my entire life. I am still relearning these. I forgot all my years of university studies and basically all of my treasured memories of family and friends. I am finding the long term memories can now be remembered if they are triggered, however some have just gone. I experience many of the problems mentioned in above posts eg. Reading a book and picking it up the next day and not remembering what I have read (interestingly this happens with fiction but not as often with non-fiction). I find words on the tip of my tongue but my brain just can't seem grab them, several hours later the word will pop into my head. I can't retain appointments etc & must write down everything. I have developed strategies to help me deal with the memory loss and continue to seek out memory building techniques. However, serious attention must be given to this issue, as others have stated it is a devastating long term side effect of ECT and one which I believe can be at least partially rectified with memory specific treatment after ECT.

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