Assessment of Cognitive Status Pre- and Postmodified Electroconvulsive Therapy in Patients with Severe Depression: A Prospective Study

Background: Depression is a disorder of concern that affects globally and has become the second leading cause of disability-adjusted life years. The disorder is characterized by persistent sad mood, loss of interest in previous pleasurable activities, reduced energy level, suicidal thoughts, and cognitive disturbances. Electroconvulsive therapy (ECT) is a rapid and effective treatment for severe depression. However, there was stigma toward the application of modified ECT (MECT), the major among them is diminished cognitive particularly memory disturbance. Studies claim that memory disturbances are transient and short-lived. Hence, the current study’s aim is to assess the cognitive status of severe depression patients before and after ECT. Materials and Methods: It is a hospital-based longitudinal analytical study conducted in the psychiatry inpatient department. Ninety-two patients fulfilling the criteria for depression as per DSM-5 were taken into the study after inclusion and exclusion criteria and informed consent. The symptoms of depression are assessed using the Hamilton Depression Rating Scale (HAM-D) and cognitive functions are assessed with Addenbrooke’s Cognitive Examination Scale - Revised (ACE-R). The scale is administered before ECT, post-ECT on day 3, 1 month, and 3 months, respectively. Results: The mean age was 34 years. The majority belonged to the age group of 20–30 years (50%) and were educated up to high school (35%). Before ECT, the mean ACE-R score was 79.39. On day 3 after ECT, the mean score was 78.97. One month after ECT, the mean score was 82.82. Three months after ECT, the mean score was 85.15. The ACE-R scores started to increase at 1 month and at 3 months after ECT, which was statistically significant ( P < 0.05). Before ECT, the mean HAM-D score was 24.41. On day 3 after ECT, the mean HAM-D score was 14.84. One month after ECT, the mean HAM D score was 9.06. Three months after ECT, the mean HAM-D score was 4.43. The decline in HAM-D score from baseline to 3 months after ECT (24.41–4.43) was statistically significant ( P < 0.05). Conclusion: The cognitive impairments due to MECT occur only in the immediate phase following MECT. The impairments are transient and short-lived and improvement in cognition occurs over time.