Electroconvulsive Therapy and Autobiographical Memory — Current landscape and possible ways forward

Abstract

Despite electroconvulsive therapy (ECT) being the most effective treatment for severe depressive episodes in affective illnesses, it is surrounded by substantial stigma, leaving patients concerned with how it may affect their memory. While most cognitive sideeffects are only transient, ECT’s impact on autobiographical memory (AM) in the long term is currently uncertain. This is likely amplified by methodological challenges, as well as the finding that the depressive episodes targeted by ECT seem to have a discernible impact on AM of their own. This bachelor’s thesis aims to contribute to the comprehension of ECT’s effect on AM by investigating the utility of a measure previously unused for this purpose, the Autobiographical Memory Test (AMT), in two novel empirical studies: The first was conducted alongside this thesis and is an on-going longitudinal clinical study, attempting to disentangle the influence of ECT from that of depressive episodes themselves by employing AMT. The second, a previous study with hitherto unused functional magnetic resonance imaging (fMRI) data, was made available for an analysis probing the suitability of the AMT for neural investigations.

In the clinical study, tentative analyses comparing one patient with 21 healthy controls revealed the existence of AM-impairment prior to ECT, with an additional decline following treatment. This finding was in line with other studies and supports the existence of AM-deficits related to both depressive episodes and ECT. Nevertheless, conclusions are preliminary given the early stage of this study, which posed considerable limitations on inference. In the fMRI study, 28 patients who had received ECT were eligible for analysis. On a group-level, the paradigm engaged brain areas aligned with current knowledge on the neural correlates of AM. While this reinforces the feasibility of the AMT when investigating ECT’s effect on AM in the brain, several statistical caveats may have influenced its results.

Overall, this present thesis aspires to contribute to the understanding of how ECT affects AM by investigating the utility of AMT within this field. Ultimately, this was motivated by the hope that doing so could lead to a more well-informed clinical practice, reducing stigma, and ultimately benefiting patients.

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