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Does electro convulsive therapy affect cognition when used for older people diagnosed with depression? A review of the literature

Brogan Watson Community mental health nurse, Rotherham Doncaster and South Humber NHS Foundation Trust Steve Hemingway Senior lecturer in mental health, University of Huddersfield



This paper presents a review of the literature about how ECT can effect cognition in older people diagnosed with depression. Using the review evidence it also reports on the ways in which ECT has been used and consequent effects on cognition and depression.

Key words

ECT, electro convulsive therapy, older people, depression, cognition, side-effects


Electro convulsive therapy (ECT) is a recommended use of treatment for the achievement of rapid improvements when a person is suffering with severe mental health symptoms. This is usually seen as a last resort treatment, when previous treatments including medication have been ineffective (NICE, 2009).

ECT has been said to be effective when used on people who are identified as severely depressed and who have not responded well to multiple uses of medication and/ or those who are at risk of suicidal ideation/intent (Kellner et al, 2012). It is a form of treatment that has been used since the 1940s and over time has been developed and improved (APA, 2017).

Major depression can affect a small percentage of people aged over 65 (around 3%) and treatment options may not be the same as the younger population (Thomas and O’Brien, 2006).

The American Psychiatric Association (2010) found there has been a lack of success in treating older people, with ineffective use of medication or intolerable sideeffects (Benbow, 2013). Therefore, ECT is becoming more prevalent as a treatment for the elderly.

Research has indicated that ECT can be highly effective in alleviating symptoms of major depression (APA, 2016), yet there is evidence that it can cause short or long-term deficits in memory, for example difficulty recalling past events (retrograde amnesia) and current events (anterograde amnesia).

NICE (2009) has also suggested that cognitive impairment can be a symptom associated with certain mental health problems and so it can be difficult to differentiate between the effects of ECT and the condition itself. Another factor is that although cognitive effects can be caused by the use of ECT, they are short-lived (Fink, 2004).

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About Mental Health Nursing

The August/September issue of MHN is a special themed edition on ECT, including: - The history and use of ECT in modern practice • Service user views • Using recovery staff in ECT anaesthesia • Student perspectives on ECT • The National Association for Lead Nurses in ECT • Interview with an ECT lead nurse • Organising a Twitter chat on ECT