Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression that we have today. After ECT treatment, about 80% of the patients typically experience a marked improvement in their symptoms, suicide risk is reduced significantly. However, despite the high impact of ECT on the majority of patients, the mechanisms behind the efficacy of treatment have not yet been established. Furthermore, there is still debate about possible side effects of the treatment, including whether the treatment results in cognitive impairments. Of these, the influence of the autobiographical memory function is particularly unpleasant and feared. The autobiographical memory constitutes the personal memories of our lives and represents an important part of our identity.
We will investigate the effects and side effects of ECT, as well as find predictors of efficacy, relapse and side effects.
Method: The project will consist of two parts (Work Package 1 and Work Package 2):
- WP1: The first part of the project investigates structural brain changes in patients with depression before, just after and 6 months after an ECT-series, using modern MRI techniques.
- WP2: The second part of the project, also examines the cognitive level of functioning, including the autobiographical memory, 6 months after the end of the ECT-series with a comprehensive neuropsychological test battery. The purpose of this part of the project is, among other things, to elucidate the dreaded side effects on the memory after ECT, as well as to compare this with MRI findings of structural brain changes. The ultimate goal will be to develop a model that can explain and potentially predict cognitive impairments following ECT.
In WP1 we plan to investigate 60 patients from the Capital Region of Denmark's psychiatric centers. WP2 is nationwide, therefore we cooperate with psychiatry in Vejle and Vordingborg to find 200 patients for this part of the project.
Results and conclusion:
Our expectations of what we can achieve with the project are to improve the advice of patients who need to decide if they want ECT. First and foremost, we expect the project to elucidate the mechanisms behind the effect of ECT, and provide answers to the extent to which the treatment entails cognitive side effects. In doing so, we expect to be able to find predictors of treatment effect, side effects and relapse. If these expected results are achieved, the long-term goal will be to implement the use of neuropsychological testing and MRI scans prior to ECT, as practices in the Capital Region of Denmark and across the world. In continuation of this, it is expected that the project results will contribute to more knowledge and understanding of ECT as an effective and safe treatment method, thus creating greater security for the health care staff, the patients themselves and their relatives.