TY - JOUR
T1 - Pharmacological interventions to diminish cognitive side effects of electroconvulsive therapy
T2 - A systematic review and meta-analysis
AU - Verdijk, Joey P.A.J.
AU - van Kessel, Mike A.
AU - Oud, Matthijs
AU - Kellner, Charles H.
AU - Hofmeijer, Jeannette
AU - Verwijk, Esmée
AU - van Waarde, Jeroen A.
N1 - Funding Information:
There was no funding source for this study. Study concept and design were drafted by EV, JV, MvK and JvW. JV, MvK and JvW collected data. JV and MO performed data analysis. All authors had full access to all the data in the study. JV, MvK and JvW verified the data set. Data interpretation and drafting of the manuscript were performed by all authors. All authors had full responsibility for the decision to submit for publication. EV en JvW contributed equally regarding the supervision of this study.
Publisher Copyright:
© 2022 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.
PY - 2022/4
Y1 - 2022/4
N2 - Objective: The authors conducted a systematic review and meta-analysis of pharmacological interventions to diminish cognitive side effects of ECT. Methods: Electronic databases of Pubmed, PsycInfo, Embase and Scopus were searched from inception through 1 April, 2021, using terms for ECT (e.g. electroconvulsive therapy), cognitive outcome (e.g. cogni*) and pharmacological intervention (e.g. calcium channel blocker and general terms, like protein). Original studies with humans receiving ECT were included, which applied pharmacological interventions in comparison with placebo or no additive intervention to diminish cognitive side effects. Data quality was assessed using Risk of Bias and GRADE. Random-effects models were used. PROSPERO registration number was CRD42021212773. Results: Qualitative synthesis (systematic review) showed 52 studies reporting sixteen pharmacological intervention-types. Quantitative synthesis (meta-analysis) included 26 studies (1387 patients) describing twelve pharmacological intervention-types. Low-quality evidence of efficacy was established for memantine (large effect size) and liothyronine (medium effect size). Very low-quality evidence shows effect of acetylcholine inhibitors, piracetam and melatonin in some cognitive domains. Evidence of no efficacy was revealed for ketamine (very low-quality), herbal preparations with anti-inflammatory properties (very low to low-quality) and opioid receptor agonists (low-quality). Conclusion: Memantine and liothyronine are promising for further research and future application. Quality of evidence was low because of differences in ECT techniques, study populations and cognitive measurements. These findings provide a guide for rational choices of potential pharmacological intervention research targets to decrease the burden of cognitive side effects of ECT. Future research should be more uniform in design and attempt to clarify pathophysiological mechanisms of cognitive side effects of ECT.
AB - Objective: The authors conducted a systematic review and meta-analysis of pharmacological interventions to diminish cognitive side effects of ECT. Methods: Electronic databases of Pubmed, PsycInfo, Embase and Scopus were searched from inception through 1 April, 2021, using terms for ECT (e.g. electroconvulsive therapy), cognitive outcome (e.g. cogni*) and pharmacological intervention (e.g. calcium channel blocker and general terms, like protein). Original studies with humans receiving ECT were included, which applied pharmacological interventions in comparison with placebo or no additive intervention to diminish cognitive side effects. Data quality was assessed using Risk of Bias and GRADE. Random-effects models were used. PROSPERO registration number was CRD42021212773. Results: Qualitative synthesis (systematic review) showed 52 studies reporting sixteen pharmacological intervention-types. Quantitative synthesis (meta-analysis) included 26 studies (1387 patients) describing twelve pharmacological intervention-types. Low-quality evidence of efficacy was established for memantine (large effect size) and liothyronine (medium effect size). Very low-quality evidence shows effect of acetylcholine inhibitors, piracetam and melatonin in some cognitive domains. Evidence of no efficacy was revealed for ketamine (very low-quality), herbal preparations with anti-inflammatory properties (very low to low-quality) and opioid receptor agonists (low-quality). Conclusion: Memantine and liothyronine are promising for further research and future application. Quality of evidence was low because of differences in ECT techniques, study populations and cognitive measurements. These findings provide a guide for rational choices of potential pharmacological intervention research targets to decrease the burden of cognitive side effects of ECT. Future research should be more uniform in design and attempt to clarify pathophysiological mechanisms of cognitive side effects of ECT.
KW - cognitive outcome
KW - electroconvulsive therapy
KW - meta-analysis
KW - pharmacological interventions
KW - systematic review
KW - UT-Hybrid-D
UR - http://www.scopus.com/inward/record.url?scp=85124561500&partnerID=8YFLogxK
U2 - 10.1111/acps.13397
DO - 10.1111/acps.13397
M3 - Review article
C2 - 35075641
AN - SCOPUS:85124561500
SN - 0001-690X
VL - 145
SP - 343
EP - 356
JO - Acta Psychiatrica Scandinavica
JF - Acta Psychiatrica Scandinavica
IS - 4
ER -