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October 24/31, 2007

Electroconvulsive Therapy and Memory Loss

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(16):1862. doi:10.1001/jama.298.16.1862-a

To the Editor: In their Commentary regarding the value of electroconvulsive therapy (ECT), Drs Fink and Taylor1 did not address an important consideration in its use. They state that the effect of ECT on memory is “circumscribed and mostly transient” and that there is only a “modest cognitive advantage of high-dose unilateral ECT.”

However, some forms of ECT are associated with an increased risk of persistent long-term effects on cognitive performance in community settings. In a cohort study, bilateral ECT was associated with broader and more severe short-term and long-term cognitive effects than right unilateral ECT; adverse cognitive effects could persist for an extended period, and “only receipt of bilateral treatment distinguished the group with marked and persistent retrograde amnesia.”2 In addition, a small study found that during the interictal stage of bilateral ECT, enhanced left frontotemporal theta activity was correlated with retrograde amnesia,3 suggesting that left medial temporal lobe structures are involved in the pathophysiology of ECT-induced memory effects.

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