Emotional Memory Retrieval Prior to Electroconvulsive Therapy in Patients With Major Depressive Disorder

comforting patient, depression
Can emotional memory retrieval just prior to electroconvulsive therapy sessions improve the outcome of ECT in patients with major depressive disorder?

Use of emotional memory reactivation (EMR) immediately prior to electroconvulsive therapy (ECT) sessions in patients with major depressive disorder (MDD) does not appear to improve the efficacy of ECT, reduce the time to response, or decrease the relapse rate. A multicenter, randomized clinical trial on the subject was conducted between 2014 and 2018 in the psychiatry departments at 3 hospitals in the Netherlands. Results of the analysis were published in the journal JAMA Open Network.

Recognizing that the impact of emotional memory retrieval on cognitive schemas remains unknown, the investigators sought to evaluate whether emotional memory retrieval right before patients receive ECT sessions can improve outcomes among those with MDD. The current study randomized a total of 72 participants in a 1:1 ratio to 1 of 2 parallel groups, to receive either EMR prior to ECT sessions (EMR-ECT arm) or control memory reactivation (CMR) interventions prior to ECT sessions (CMR-ECT arm). All study enrollees were between 18 and 70 years of age, had a primary diagnosis of unipolar MDD, and had an indication for ECT.

The Hamilton Depression Rating Scale (HDRS [range of scores, 0 to 52, with scores of 0 to 7 indicative of no depression and scores ≥24 indicative of severe depression]) was utilized to gauge symptoms of depression during and after ECT, with a 6-month follow-up. The main study outcomes were depression scores and relapse rates within

6 months, per analysis of participants’ HDRS scores.

Following the withdrawal of 6 patients from the original group of 72 randomized individuals, a total of 66 participants were included in the final analysis — 32 of whom were in the EMR-ECT group and 34 of whom were in the CMR-ECT group. The mean patient age was 49.3 ± 12.3 years and 59.1% of the participants were women.

Regardless of the memory intervention that was used, 42.4% (28 of 66) of the participants demonstrated a response, which was defined as a ≥50% reduction in symptom severity on the HDRS. Among those individuals who responded, 39.3% (11 of 28) experienced a relapse within 6 months.

No significant differences were reported between the 2 intervention arms:

(1) remission rates: CMR-ECT arm, 29.4% vs EMR-ECT arm, 25.0%; P =.58; (2) mean HDRS scores after the ECT course: CMR-ECT arm, 14.6 ± 8.6 vs EMR-ECT arm, 14.9 ± 8.8; P =.88); (3) total mean number of ECT sessions required for response: CMR-ECT arm, 14.9 ± 7.9 vs EMR-ECT arm, 15.6 ± 7.3; P =.39); and (4) relapse rates: CMR-ECT arm, 46.7% vs EMR-ECT arm, 30.8%; P =.33.

The investigators concluded that this randomized controlled trial underscores the problems involved in translating insights gained from laboratory research into clinical practice. Additional studies are warranted, in order to further improve the use of ECT in patients with severe MDD.


Scheepens DS, van Waarde JA, ten Doesschate F, et al. Effectiveness of emotional memory reactivation vs control memory reactivation before electroconvulsive therapy in adult patients with depressive disorder: a randomized clinical trial. JAMA Netw Open.  2020;3(8):e2012389. doi: 10.1001/jamanetworkopen.2020.12389