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Confusional States During Electroconvulsive Therapy for Late-Life Depression: A Prospective Cohort Study
Thomas C Feenstra1,2, Nathalie Denayer3, Kristof Vansteelandt3
1GGZ Centraal Mental Health Care, Amersfoort, the Netherlands.
Acta Psychiatrica Scandinavica
|March 18, 2025
Summary
Confusional states are common during electroconvulsive therapy (ECT) in older adults with depression, affecting over half of patients. These heterogeneous states, including postictal agitation and prolonged disorientation, can occur anytime during ECT treatment.
Area of Science:
- Geriatric Psychiatry
- Neuroscience
- Clinical Psychology
Background:
- Electroconvulsive therapy (ECT) is an effective treatment for severe depression, particularly in older adults.
- While cognitive side effects like memory loss are well-documented, (sub)acute confusional states during ECT are less understood in this population.
- Older adults with depression represent a vulnerable group where understanding ECT-induced cognitive changes is critical.
Purpose of the Study:
- To investigate the incidence, recurrence, co-occurrence, and clinical course of various subtypes of confusional states during electroconvulsive therapy (ECT).
- To specifically examine these confusional states in older adults (≥55 years) diagnosed with a major depressive episode.
- To provide a comprehensive description of these adverse events in a late-life depression cohort.
Main Methods:
- Prospective cohort study (RECALL) including 145 older adults (≥55 years) with major depressive episode undergoing ECT.
- Assessment of confusional state subtypes: postictal and interictal delirium (PID/IID), postictal agitation (PIA), prolonged time to reorientation (TRO), and subacute cognitive decline.
- Data collected throughout the entire course of ECT treatment.
Main Results:
- Over half (55.9%) of older adults experienced at least one confusional state subtype during ECT.
- Postictal agitation (PIA) and prolonged time to reorientation (TRO) were the most prevalent subtypes.
- Interictal delirium and prolonged TRO showed high recurrence rates (66.7% and 50.0%, respectively); 18.0% experienced multiple subtypes.
Conclusions:
- Confusional states are highly prevalent and heterogeneous during ECT in older adults with depression.
- These states can emerge at any point during the ECT course and exhibit varying recurrence patterns.
- Further research is needed to differentiate (sub)acute confusional states, as current assessment tools may not be fully adequate for ECT contexts.
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