Cognitive Side Effects of Electroconvulsive Therapy: A Case-Control Comparison in Obsessive-Compulsive and Depressive Disorders

Background: Electroconvulsive Therapy (ECT) is well-established for treating psychiatric disorders like depression, mania, schizophrenia, and catatonia, especially in resistant cases. Its role in Obsessive-Compulsive Disorder (OCD), however, remains controversial. While OCD is typically managed with cognitive-behavioral therapy (CBT) and antidepressants, some patients remain resistant. ECT may modulate neurotransmitter systems involved in OCD and comorbid depression, but guidelines are divided: DGPPN (2022) advises against it, while WFSBP recommends it before Deep Brain Stimulation. Cognitive side effects are a concern, though less pronounced in OCD than depression. This study assesses ECT’s cognitive impact in OCD versus depression to inform its safety and efficacy.

Method: We present a case series of 4 patients diagnosed with difficult-to-treat OCD according to the ICD-10 criteria, who underwent 12 acute ECT sessions over 3 to 4 weeks, followed by maintenance therapy. Matched (year of birth and gender) MDD patients served as controls. Cognitive function was assessed at four time points using the MoCA (before, during, and twice after the ECT acute series).

Results: ECT significantly reduced OCD and depression symptoms in all patients. However, cognitive outcomes differed: Three of four OCD patients showed minimal score changes across baseline (T0), T1 and T2 (≤2 points), while matched MDD patients had declines of up to six points between T0 and T1, alongside greater overall variability.The results diverged for the fourth matched pair. The OCD patient experienced a four-point reduction in cognitive performance between T0 and T1, whereas the MDD patient demonstrated a three-point improvement over the same period.

Conclusion: These findings suggest that while ECT offers similar symptom relief, its cognitive effects are more pronounced and variable in MDD than in OCD. This may indicate greater cognitive resilience in OCD.

Publikationsverlauf

Artikel online veröffentlicht:
30. April 2025