Pharmacological interventions to diminish cognitive side effects of electroconvulsive therapy: A systematic review and meta-analysis.

Autor: Verdijk JPAJ; Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands.; Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands., van Kessel MA; Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.; Antes PG (Parnassia Group), Mental Health Services, Rotterdam, The Netherlands., Oud M; Trimbos Institute, Utrecht, The Netherlands., Kellner CH; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA., Hofmeijer J; Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands.; Department of Neurology, Rijnstate Hospital, The Netherlands., Verwijk E; Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.; Department of Medical Psychology, Neuropsychology, Amsterdam UMC, Amsterdam, The Netherlands.; ECT Department Haaglanden, Parnassia Psychiatric Institute, The Hague, The Netherlands., van Waarde JA; Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands.
Jazyk: angličtina
Zdroj: Acta psychiatrica Scandinavica [Acta Psychiatr Scand] 2022 Apr; Vol. 145 (4), pp. 343-356. Date of Electronic Publication: 2022 Feb 08.
DOI: 10.1111/acps.13397
Abstrakt: 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.
(© 2022 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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