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Electroconvulsive Therapy01:30

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Long-term depression, or LTD, is one of the ways by which synaptic plasticity—changes in the strength of chemical synapses—can occur in the brain. LTD is the process of synaptic weakening that occurs over time between pre and postsynaptic neuronal connections. The synaptic weakening of LTD works in opposition to synaptic strengthening by long-term potentiation (LTP) and together are the main mechanisms that underlie learning and memory.
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Prognostic Factors for Postictal Agitation After Electroconvulsive Therapy in Older Adults With Depression.

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Lithium, Electroconvulsive Therapy and Cognition: A Systematic Review and Meta-Analysis.

Liese Van den Eynde1, Akihiro Takamiya2,3, Kristof Vansteelandt1

  • 1Neuropsychiatry, Department of Neurosciences, University Psychiatric Center KU Leuven - University of Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Leuven, Belgium.

Acta Psychiatrica Scandinavica
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PubMed
Summary

Concurrent lithium and electroconvulsive therapy (ECT) use does not significantly increase confusional states or cognitive changes. Further research is needed, but current evidence supports cautious continuation of lithium during ECT for improved patient outcomes.

Keywords:
ECTcognitionconfusional stateselectroconvulsive therapylithiumside‐effects

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Area of Science:

  • Neuroscience and Psychiatry
  • Clinical Pharmacology
  • Evidence Synthesis and Meta-Analysis

Background:

  • Lithium is a mood stabilizer commonly used in psychiatric practice.
  • Electroconvulsive therapy (ECT) is an effective treatment for severe mental illnesses.
  • The concurrent use of lithium and ECT (Li-ECT) raises concerns regarding potential cognitive side effects.

Purpose of the Study:

  • To systematically synthesize existing evidence on confusional states and neurocognitive changes associated with Li-ECT.
  • To compare the incidence of cognitive side effects in patients receiving Li-ECT versus ECT alone.
  • To inform clinical decision-making regarding the safety of combined Li-ECT treatment.

Main Methods:

  • Systematic literature search across multiple databases (PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, CINAHL, PsycArticles) and clinical trials registries up to September 2025.
  • Meta-analysis of dichotomous (confusional states) and continuous (neurocognitive test scores) outcomes using Restricted Maximum-Likelihood and Paule-Mandel methods.
  • Synthesis of case reports detailing cognitive effects of Li-ECT.

Main Results:

  • Analysis of 16 studies (11 on confusional states, 5 on neurocognitive changes) involving over 66,000 patients.
  • No significant association between lithium use and confusional states in the primary meta-analysis (OR 2.09; p=0.07), though a sensitivity analysis suggested significance (OR 2.38; p=0.01).
  • No significant differences observed in changes in global cognitive functioning, autobiographical memory, or verbal fluency between Li-ECT and ECT alone.

Conclusions:

  • Current evidence does not demonstrate a significant increase in cognitive side effects with concurrent lithium and ECT use.
  • Methodological limitations and clinical heterogeneity necessitate caution and preclude definitive conclusions.
  • Large prospective studies with standardized assessments are required; individualized decision-making remains critical.