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ECT and Permanent Memory Loss in Severe Depression Patients Assignment Sample

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Introduction

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Nowadays, depression is getting a common illness among the population. According to World Health Organisation, 3.8% of the global population are now living with depression, among which 5.7% belong to the age group of 60 years or older. At the current time, people who are living with severe or hard-to-treat depression are being recommended for electroconvulsive therapy. This therapy sometimes is termed “electroshock therapy”.

This therapy is often misunderstood as a harsh treatment, but in reality, it is a painless medical process and the most effective treatment for severe depression. Though, this therapy's most common and terrible side effect is long-term or permanent memory loss.

Aim or Purpose

The aim of this assignment is to systematically review current and existing literature to understand whether the Electroconvulsive treatment can cause permanent memory loss for the patient with severe depression or not. The purpose of this assignment is to identify the effect of Electroconvulsive therapy on patients with depression. Additionally, in this assignment, different literatures will be assessed to address the extent to which it is true that ECT can cause permanent memory loss.

Method

To meet the aim or purpose of this assignment, a secondary research method has to be used. More specifically, to meet the research aim, current literature will be collected from online sources and assessed for the research purpose. Therefore, to select the most relevant research articles from online portals, a search engine will be the best-suited search strategy.

Search strategy

  1. Search filters- considering the aim and objectives of the proposed assignment, the appropriate search filters will be:
  2. PubMed: clinical queries and health services research queries
  3. CINAHL: EBSCOhost’s main search page for health care and service-related articles and reviews
  4. Embase & PsycINFO
  5. National Library of Medicine (NIH)
  6. Australian Journal of Psychology
  7. Annual Review of Psychology

Keyword Search: this search strategy can help broaden the result. For this proposed research, the keywords will be:

  1. Electroconvulsive treatment or ECT
  2. Depression; Electroconvulsive therapy
  3. Retrograde Amnesia; ECT
  4. Electroconvulsive therapy; Permanent Memory loss

Quality appraisal tool

The clinical Appraisal Skills Programme or CASP tool has to be used for this research to appraise the quality of the research. With the CASP tool, the researcher can systematically examine the relevance of the review and articles being assessed for this proposed work. Additionally, with the CASP tool researcher can apprise the research evidence on the basis of relevance, trustworthiness, and value in reference to the respective context (Long et al., 2020).

Flow chart of the literature search:

Inclusion and exclusion criteria j have been used to select the most relevant and accountable literature from the online portal for this assignment. The aim of this proposed research is to evaluate whether the Electroconvulsive treatment or therapy can cause permanent memory loss for the patient with depression or not (Read, 2022). For the systematic review, the inclusion criteria of the research journals and articles will be:

  1. The articles, journals and literature that contain information about the ECT or Electroconvulsive treatment
  2. Articles, journals and literature which contain information about the correlation between depression and ECT or electroconvulsive therapy
  3. Articles and literature that have already focused on the relation between memory loss and electroconvulsive therapy for the patient with depression
  4. Articles, journals and literature reviews which are published on 2010 or after

Exclusion criteria:

  1. Articles, journals, and Literature reviews which are published before 2010
  2. Articles and literature reviews or medical journals that do not contain any information about the onset of depression and ECT as the treatment of depression
  3. Articles and journals which do not contain any information or data that provide insight into the shared relation between ECT and permanent memory loss among the patient with depression
  4. Articles and journals which are not written in the English language and do not publish on clinical websites

Results 10 articles

Paper name and Author

Aim or Purpose

Methodology

participants

Key findings

The long-term impact of treatment with electroconvulsive therapy on discrete memory systems in patients with bipolar disorder

Author: Glenda MacQueen, MD PhD, Caroline Parkin, BSc, Michael Marriott, PhD, Helen Bégin, RN, and Gary Hasey, MD

Year: 2010

Electroconvulsive therapy is controversially associated with long-term memory problems.

Primary quantitative research method

Memory assessment tool: California Verbal Learning Test, Continuous Visual Memory Test

Participants are separated into three groups: a group of healthy people (control)

A group of people with BD and received ECT at least 6 months before memory assessment.

Another group: individuals with BD but never received ECT.

Patients had abnormalities in language learning and memory compared to healthy controls. When compared to patients who had never had remote ECT, subjects who had received it experienced more impairment on a range of learning and memory tests. This level of impairment could not be explained by the patient’s current sickness status or by differences in their prior illness burden.

Depression, Memory and electroconvulsive therapy

Author: Rudi Coetzer

Year: 2019

The correlation between depression, Memory and ECT – to check whether ECT can cause permanent memory loss for the patient with depression

Secondary qualitative research

Existing literature reviews and journals

Current neuroscience research indicates that short-term memory deficits are typical immediately following electroconvulsive therapy (ECT), and longer-term issues are less frequent. Our understanding of longer-term cognitive issues following ECT, such as memory function, is still lacking. Some of these have to do with the difficulties involved in conducting cognitive tests and interpreting test findings.

Patient Experience of Electroconvulsive Therapy

A Retrospective Review of Clinical Outcomes and Satisfaction

Author: Brown, Sarah K. DrPH; Nowlin, Rachel B. MS; Sartorelli, Rebecca BA; Smith, Johan MBA; Johnson, Karen MSW

Year: 2018

To explore the patient perception of memory loss and ECT or electroconvulsive therapy by assessing the real-world experiences of adult patients who already have received ECT.

Primary quantitative research method

Survey: Patient Satisfaction Survey

Sample size: 1089 adult patients with depression, BD or bipolar disorder and availing 23 psychiatric facilities in the United States

The majority of patients who receive ECT report being satisfied with their care and seeing a decrease in their depression symptoms and side effects over time. Patients reported less depression, with an average change of 13.2 on the Patient Health Questionnaire between intake and final ECT session (P 0.001). In addition, 85.5% of patients said their ECT helped them or made them feel better in the Patient Satisfaction Survey. The capacity to resume social and professional activities and the relief of depressive symptoms were found to be significant factors in determining treatment satisfaction. At the same time, side effects, including memory issues, had less of an impact.

Electroconvulsive therapy and risk of dementia in patients with affective disorders: a cohort study

Author: Osler, M., Rozing, M.P., Christensen, G.T., Andersen, P.K. and Jørgensen, M.B., Year: 2018.

To examine the frequency of dementia among the patient after receiving ECT

A cohort study of the patients aged 10 years and more,

Individuals admitted to Danish National Patient Registry with ICD 10 codes, F30.0 to F39.9

In patients in the age group of 70 years or older, ECT is associated with a decreased rate of dementia. Supplementary analysis suggests that the risk of dementia is related to the ECT

Long-Term Cognitive and Psychological Functioning in Post–Electroconvulsive Therapy Patients

Author: Miller, M.L., Luu, H., Gaasedelen, O., Hahn-Ketter, A.E., Elmore, A., Dezhkam, N., Bayless, J., Moser, D.J. and Whiteside, D.M., Year: 2019.

To evaluate the long-term outcome of ECT on cognitive functioning, psychiatric symptoms reacted with ECT and the quality of life of individuals who already received ECT.

Primary quantitative research method

Tool: Wide range Achievement Test-4, Trail Making Test, Wechsler Adult Intelligent Scale

Sample size: N=294

the t-test showed a reduction in the mean BDI-II score. This indicates that patients with ECT have faced the problem with memory function and cognitive functioning and depressive symptom remain intact and stable for several years after receiving ECT.

Patients’, Carers’, and the Public’s Perspectives on Electroconvulsive Therapy

Author: Chris Griffiths and Alex O’Neill-Kerr

Year: 2019

To evaluate the perspective of patient carers and the public toward ECT or Electroconvulsive therapy through the narrative review.

Secondary research

 Secondary research articles and literature reviews

People’s perception of ECT is negative as it is influenced by risks and long-term effects.

Retrograde amnesia after electroconvulsive therapy: A temporary effect?

Author: Meeter, M., Murre, J.M., Janssen, S.M., Birkenhager, T. and van den Broek, W.W.,

Year: 2011.

To evaluate the impact of ECT on memory and its intensity to yield strong retrograde amnesia

Cohort study- patients undergo ECT for major depression

Tool: two memory tests were used: a verbal learning test and a remote memory test

Sample size: 21 patients experience through bilateral ECT for severe depression

135 controls

The scores of the patients were lower before ECT than those of the controls. Following therapy, they dropped once more, pointing to retrograde amnesia. However, at the follow-up time, pre-ECT memory had fully recovered. Memory for incidents that occurred in the months following therapy was comparable to controls.

Serum neurofilament light chain (NFL) remains unchanged during electroconvulsive therapy.

Author: Besse, M., Belz, M., Folsche, T., Vogelgsang, J., Methfessel, I., Steinacker, P., Otto, M., Wiltfang, J. and Zilles, D.,

Year: 2020

To understand the impact of ECT on brain damage and permanent memory loss

A primary quantitative research method to measure the neurofilament light chain reaction in patients who received ECT

Sample size: 15 patients with major depression and receiving ECT

No significant change on NFL level – NFL concentration did not differ between the healthy controls and patients.

Grey matter volume increase following electroconvulsive therapy in patients with late-life depression: a longitudinal MRI study

Author: Bouckaert, F., De Winter, F.L., Emsell, L., Dols, A., Rhebergen, D., Wampers, M., Sunaert, S., Stek, M., Sienaert, P. and Vandenbulcke, M.,

Year: 2016

To evaluate the mechanism and action of ECT on hippocampal, amygdala and cortex volume of brain cells.

Primary research method

Tool: MADRS, 3T structural MRI

Elderly patients with unipolar depression and have received ECT

After receiving ECT, the right hemispheric grey matter volume jas increased along with the medial lobe, insula and posterior superior temporal region of the brain cell, and that indicates the negative impact of ECT on the brain

Effect of Electroconvulsive Therapy on Striatal Morphometry in Major Depressive Disorder

Author: Wade, B.S., Joshi, S.H., Njau, S., Leaver, A.M., Vasavada, M., Woods, R.P., Gutman, B.A., Thompson, P.M., Espinoza, R. and Narr, K.L.,

Year: 2016

To evaluate the effect of Electroconvulsive Therapy on major depressive disorder

Primary quantitative research method

53 patients with significant depression and received ECT at the University of California, Los Angeles Resnick Neuropsychiatric Hospital

ECT causes surface deformation in the striatum in the short-term interval and provide a negative impact on the neurotrophic factor that causes significant depression

Discussion key findings

Considering the systematic analysis of literature and articles thoroughly, a mixed result or findings can be acquired regarding the effect of electroconvulsive treatment on patients with significant or severe depression. Critical analysis of ten research articles thoroughly, it can be seen that majority of the articles state that ECT has an indirect influence on the occurrence of dementia or retrograde amnesia among the patient with severe depression. The articles which have been selected for systematic reviews include the primary research method or cohort studies on patients with bipolar disorders and severe depression and already received ECT. The structural neuroimaging, functional neuroimaging and metabolic studies refer that ECT can cause a sudden change in the hippocampus, amygdala, grey matter, white matter and certain parts of the limbic system in the brain cell. According to some research articles, ECT can cause degeneration of neurons and cause cognitive impairment among patients with severe depression. Therefore, most studies indicate that ECT can cause temporary or long-term brain damage or lead patients with BD and depression to memory loss.

Conclusion

This assignment aims to conduct a systematic review of the literature to address the impact of electroconvulsive treatment or therapy on a patient with severe depression. This assignment has also sought to identify whether ECT can cause memory loss for the patient with depression or not. Therefore, ten articles have been selected for this proposed assignment and assessed thoroughly using the CASP tool. Considering the analysis and findings, it can be concluded that ECT is related to the degeneration or damage of brain cells, which can cause short- or long-term memory loss for patients with severe depression.

References

Besse, M., Belz, M., Folsche, T., Vogelgsang, J., Methfessel, I., Steinacker, P., ... & Zilles, D. (2020). Serum neurofilament light chain (NFL) remains unchanged during electroconvulsive therapy. The World Journal of Biological Psychiatry21(2), 148-154.https://www.tandfonline.com/doi/abs/10.1080/15622975.2019.1702717

Bouckaert, F., De Winter, F. L., Emsell, L., Dols, A., Rhebergen, D., Wampers, M., ... & Vandenbulcke, M. (2016). Grey matter volume increase following electroconvulsive therapy in patients with late life depression: a longitudinal MRI study. Journal of Psychiatry and Neuroscience41(2), 105-114.https://www.jpn.ca/content/41/2/105.abstract

Brown, S. K., Nowlin, R. B., Sartorelli, R., Smith, J., & Johnson, K. (2018). Patient experience of electroconvulsive therapy: a retrospective review of clinical outcomes and satisfaction. The journal of ECT34(4), 240-246.https://journals.lww.com/ectjournal/Fulltext/2018/12000/Patient_Experience_of_Electroconvulsive_Therapy__A.6.aspx

Coetzer, R. (2019). Depression, memory and electroconvulsive therapy. BJPsych Bulletin43(2), 51-53.https://www.cambridge.org/core/journals/bjpsych-bulletin/article/depression-memory-and-electroconvulsive-therapy/EF89C888DA73B02002B78BBC0193CA45

Griffiths, C., & O’Neill-Kerr, A. (2019). Patients’, Carers’, and the Public’s Perspectives on Electroconvulsive Therapy. Frontiers In Psychiatry10. https://doi.org/10.3389/fpsyt.2019.00304

Long, H. A., French, D. P., & Brooks, J. M. (2020). Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Research Methods in Medicine & Health Sciences1(1), 31-42.https://journals.sagepub.com/doi/abs/10.1177/2632084320947559

Maric, N., Stojanovic, Z., Andric, S., Soldatovic, I., Dolic, M., & Spiric, Z. (2015). The acute and medium-term effects of treatment with electroconvulsive therapy on memory in patients with major depressive disorder. Psychological Medicine46(4), 797-806. https://doi.org/10.1017/s0033291715002287

Meeter, M., Murre, J. M., Janssen, S. M., Birkenhager, T., & van den Broek, W. W. (2011). Retrograde amnesia after electroconvulsive therapy: a temporary effect?. Journal of Affective Disorders132(1-2), 216-222.https://www.sciencedirect.com/science/article/pii/S0165032711000802

Miller, M. L., Luu, H., Gaasedelen, O., Hahn-Ketter, A. E., Elmore, A., Dezhkam, N., ... & Whiteside, D. M. (2019). Long-Term Cognitive and Psychological Functioning in Post–Electroconvulsive Therapy Patients. The journal of ECT35(1), 27-34.https://journals.lww.com/ectjournal/Fulltext/2019/03000/Long_Term_Cognitive_and_Psychological_Functioning.7.aspx

Osler, M., Rozing, M. P., Christensen, G. T., Andersen, P. K., & Jørgensen, M. B. (2018). Electroconvulsive therapy and risk of dementia in patients with affective disorders: a cohort study. The Lancet Psychiatry5(4), 348-356.https://www.sciencedirect.com/science/article/pii/S2215036618300567

Read, J. (2022). A response to yet another defence of ECT in the absence of robust efficacy and safety evidence. Epidemiology and Psychiatric Sciences, 31.https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/response-to-yet-another-defence-of-ect-in-the-absence-of-robust-efficacy-and-safety-evidence/A9E878F53979A44ED9E5FF0DC269C187

Wade, B. S., Joshi, S. H., Njau, S., Leaver, A. M., Vasavada, M., Woods, R. P., ... & Narr, K. L. (2016). Effect of electroconvulsive therapy on striatal morphometry in major depressive disorder. Neuropsychopharmacology41(10), 2481-2491.https://www.nature.com/articles/npp201648

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