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Subjective Memory Immediately Following Electroconvulsive Therapy

Brus, Ole MSc*; Nordanskog, Pia MD, PhD†‡; Båve, Ullvi MD, PhD§; Cao, Yang PhD*∥; Hammar, Åsa MD, PhD¶#; Landén, Mikael MD, PhD**††; Lundberg, Johan MD, PhD‡‡; Nordenskjöld, Axel MD, PhD§§

doi: 10.1097/YCT.0000000000000377
Original Studies

Objectives The aims of the present study were to describe the short-term rate of subjective memory worsening (SMW) and identify factors of importance for SMW in a large clinical sample treated for depression with electroconvulsive therapy (ECT).

Methods This register-based study included 1212 patients from the Swedish National Quality Register for ECT. Subjective memory worsening was defined as a 2-point worsening on the memory item of the Comprehensive Psychopathological Rating Scale from before to within 1 week after treatment. Associations between patient characteristics and treatment factors were examined using logistic regression.

Results Subjective memory worsening was experienced in 26%. It was more common in women than in men (31% vs 18%; P < 0.001) and more common in patients aged 18 to 39 years than in patients 65 years or older (32% vs 22%; P = 0.008). Patients with less subjective memory disturbances before ECT had a greater risk of SMW. Patients in remission after ECT had a lower risk of SMW. A brief pulse width stimulus gave higher risk of SMW compared with ultrabrief pulse (odds ratio, 1.61; 95% confidence interval, 1.05–2.47).

Conclusions Subjective memory worsening is reported by a minority of patients. However, young women are at risk of experiencing SMW. Ultrabrief pulse width stimulus could be considered for patients treated with unilateral electrode placement who experience SMW. Each patient should be monitored with regard to symptoms and adverse effects, and treatment should be adjusted on an individual basis to maximize the clinical effect and with efforts to minimize the cognitive adverse effects.

From the *Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro; †Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping; ‡Department of Psychiatry, Region Östergötland, Linköping; §Department of Clinical Neuroscience, and ∥Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; ¶Department of Biological and Medical Psychology, University of Bergen, Bergen; #Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; **Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; ††Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg; ‡‡Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm; and §§School of Medical Sciences, Örebro University, Örebro, Sweden.

Received for publication July 11, 2016; accepted October 23, 2016.

Reprints: Ole Brus, MSc, Clinical Epidemiology and Biostatistics, X-huset, Örebro University Hospital, 701 85 Örebro, Sweden (e-mail:

This research was supported by Swedish Research Council (523-2013-2982) and the Swedish Foundation for Strategic Research.

The authors have no conflicts of interest or financial disclosures to report.

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