PMID- 36198062
OWN - NLM
STAT- MEDLINE
DCOM- 20221007
LR  - 20221101
IS  - 1555-2101 (Electronic)
IS  - 0160-6689 (Linking)
VI  - 83
IP  - 5
DP  - 2022 Oct 3
TI  - Reconsideration of the Benefits of Pharmacological Interventions for the 
      Attenuation of the Cognitive Adverse Effects of Electroconvulsive Therapy.
LID - 22f14668 [pii]
LID - 10.4088/JCP.22f14668 [doi]
AB  - The cognitive adverse effects (AEs) of electroconvulsive therapy (ECT) limit the 
      wider use of the treatment. These AEs can be attenuated by changing the way ECT 
      is administered; however, such changes may reduce the response rate, the speed of 
      response, or both. A recent systematic review and meta-analysis identified more 
      than a dozen pharmacologic interventions in 26 randomized controlled trials 
      (RCTs) that sought to reduce ECT-induced cognitive AEs. Because of large 
      differences across RCTs, only a few outcomes for a few interventions could be 
      pooled in meta-analysis, and most pooled analyses included only 2-3 RCTs. 
      Important findings were that acetylcholinesterase inhibitors, ketamine, 
      memantine, and liothyronine were associated with improved global cognitive 
      functioning at 1-14 days post-ECT. Anti-inflammatory treatments and opioid 
      receptor antagonists were not associated with improvement in general cognitive 
      outcome at 1-14 days post-ECT. Meta-analysis was not possible for the remaining 
      interventions, including piracetam, melatonin, pemoline, nortriptyline, herbal 
      agents, drugs acting on the cortisol pathway, opioid receptor antagonists, 
      l-tryptophan, vasopressin analogs, calcium channel blockers, and others; in 
      individual RCTs, some of these interventions attenuated some cognitive measures 
      as some time points after ECT. Regrettably, none of the RCTs examined clinically 
      meaningful outcomes such as subjective cognitive impairment, impairments in daily 
      life, and persistent autobiographical memory deficits. Future research should 
      study such clinically meaningful outcomes (rather than laboratory tests), using 
      pharmacologic interventions, perhaps in combination, for ECT procedures that are 
      associated with higher cognitive AE burden. A risk is that whatever attenuates 
      ECT-induced cognitive AEs may also attenuate ECT-related therapeutic benefits.
CI  - (c) Copyright 2022 Physicians Postgraduate Press, Inc.
FAU - Andrade, Chittaranjan
AU  - Andrade C
AD  - Department of Clinical Psychopharmacology and Neurotoxicology, National Institute 
      of Mental Health and Neurosciences, Bangalore, India (candrade@psychiatrist.com).
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20221003
PL  - United States
TA  - J Clin Psychiatry
JT  - The Journal of clinical psychiatry
JID - 7801243
RN  - 0 (Calcium Channel Blockers)
RN  - 0 (Cholinesterase Inhibitors)
RN  - 0 (Narcotic Antagonists)
RN  - 06LU7C9H1V (Triiodothyronine)
RN  - 690G0D6V8H (Ketamine)
RN  - 7GAQ2332NK (Pemoline)
RN  - 8DUH1N11BX (Tryptophan)
RN  - BL03SY4LXB (Nortriptyline)
RN  - JL5DK93RCL (Melatonin)
RN  - W8O17SJF3T (Memantine)
RN  - WI4X0X7BPJ (Hydrocortisone)
RN  - ZH516LNZ10 (Piracetam)
SB  - IM
MH  - Calcium Channel Blockers/therapeutic use
MH  - Cholinesterase Inhibitors
MH  - Cognition
MH  - *Electroconvulsive Therapy/adverse effects/methods
MH  - Humans
MH  - Hydrocortisone
MH  - *Ketamine/therapeutic use
MH  - *Melatonin
MH  - Memantine
MH  - Narcotic Antagonists
MH  - Nortriptyline
MH  - Pemoline
MH  - *Piracetam
MH  - Treatment Outcome
MH  - Triiodothyronine
MH  - Tryptophan
EDAT- 2022/10/06 06:00
MHDA- 2022/10/12 06:00
CRDT- 2022/10/05 14:42
PHST- 2022/10/05 14:42 [entrez]
PHST- 2022/10/06 06:00 [pubmed]
PHST- 2022/10/12 06:00 [medline]
AID - 22f14668 [pii]
AID - 10.4088/JCP.22f14668 [doi]
PST - epublish
SO  - J Clin Psychiatry. 2022 Oct 3;83(5):22f14668. doi: 10.4088/JCP.22f14668.