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To the Editor: In their Commentary regarding the value of electroconvulsive therapy (ECT), Drs Fink and Taylor¹ did not address an important consideration in its use. They state that the effect of ECT on memory is "circumscribed and mostly transient" and that there is only a "modest cognitive advantage of high-dose unilateral ECT."

However, some forms of ECT are associated with an increased risk of persistent long-term effects on cognitive performance in community settings. In a cohort study, bilateral ECT was associated with broader and more severe short-term and long-term cognitive effects than right unilateral ECT; adverse cognitive effects could persist for an extended period, and "only receipt of bilateral treatment distinguished the group with marked and persistent retrograde amnesia."² In addition, a small study found that during the interictal stage of bilateral ECT, enhanced left frontotemporal theta activity was correlated with retrograde amnesia,³ suggesting that left medial temporal lobe . . . [Full Text of this Article]

Anne B. Donahue, JD
counterp@tds.net
Vermont State House
Montpelier

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Electroconvulsive Therapy: Evidence and Challenges
Max Fink and Michael Alan Taylor
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