Silencing the black dog - Understanding cognitive side effects of electroconvulsive therapy

Electroconvulsive therapy (ECT) is the most effective treatment for major depressive disorder but is underused due to stigma, limited clinician knowledge and concerns about cognitive side effects. The thesis examines ECT side effects, particularly postictal agitation and cognitive impairment.

Severe postictal agitation occurred in 25% of patients, mainly in the first five sessions, without affecting treatment efficacy. Flumazenil given before the ECT stimulus was associated with more agitation. A randomized cross-over trial found acetaminophen and nimodipine had no effect on postictal agitation, contrary to earlier evidence. Memantine and liothyronine showed the most promise for reducing cognitive decline. Multiple MRI modalities indicated that default mode network within-network strength normalized in ECT patients.