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.