ECT and Autobiographical Memory: Report from the United Kingdom (With a Twist!)

 Out on PubMed, from investigators in the United Kingdom, is this report:

Electroconvulsive therapy related autobiographical amnesia: a review and case report.

Lomas M, Rickard V, Milton F, Savage S, Weir A, Zeman A.Cogn Neuropsychiatry. 2021 Jan 19:1-15. doi: 10.1080/13546805.2021.1871889. Online ahead of print.PMID: 33467984

The abstract is copied below:

Introduction: While short-term cognitive impairment following electroconvulsive therapy (ECT) is well described and acknowledged, the relationship between ECT and persistent memory impairment, particularly of autobiographical memory, has been controversial. Methods: We describe the case of a 70-year-old consultant neurophysiologist, AW, who developed prominent, selective autobiographical memory loss following two courses of ECT for treatment-resistant depression. Results: His performance on standard measures of IQ, semantic and episodic memory, executive function and mood was normal, while he performed significantly below controls on measures of episodic autobiographical memory. Conclusions: Explanations in terms of mood-related memory loss and somatoform disorder appear unlikely. We relate AW's autobiographical memory impairment, following his ECT, to reports of similar autobiographical memory impairment occurring in the context of epilepsy, and emphasise the importance of using sensitive approaches to AbM assessment.

The pdf is here.

And from the text:

...Between February and April 2014 he received 14 treatments with brief pulse bilateral temporal ECT, with considerable improvement in his mood. Despite continuing treatment with venlafaxine and lamotrigine, his mood again declined after 6 months, and he received a further 26 ECT treatments between December 2014 and August 2015. While these were less effective than the first series, his mood has substantially recovered on maintenance treatment with venlafaxine (525 mg/day) and lamotrigine (300 mg/day). At the time of our assessments (November 2017 and March 2018), AW regarded his mood as content, was able to take pleasure in life, felt energetic, could concentrate normally and was sleeping and eating well.

This report is interesting from a scientific, brain-mechanistic perspective, just as long as the clinical significance is not overvalued. This is a case of an older professional man with severe, life-disrupting mood disorder who is well thanks to aggressive psychiatric treatment, including ECT. That he has a very circumscribed memory deficit seems a small price to pay for his ongoing wellness. "Chemobrain" in a patient brought into remission from a potentially lethal cancer is the analogy that comes to mind.

As the authors note, his ongoing olfactory hallucinations suggest a possible form of TLE, so this case may be more atypical than commonplace.

The theoretical/mechanistic discussion of memory dysfunction in epilepsy and possible similarities to ECT is interesting. The point about using sensitive and specific neuropsychological test instruments is well taken.

The authors are psychologists, a neurologist and a "retired clinical neurophysiologist."

In the acknowledgements it says, 

"The other authors thank AW for making initial contact with them, after he noted the similarity between his memory loss post-ECT and memory loss described in the context of temporal lobe epilepsy." So "AW" is both the patient in the case report and an author. 

IMO, this should have been much more clearly disclosed. It certainly sets up the potential for bias in the cognitive tests themselves and in the reporting of results. I would be very interested in others' views of this conflict of interest and possible ethical issue.