Professor Ian Hickie’s shocking each way bet on ECT induced amnesia

 

A slightly different version of this blog written by Martin Whitely MLA was originally published on 5 March 2012 at http://www.speedupsitstill.com/2012/03/05/professor_ian_hickies_shocking_bet_ect_induced_amnesia

 

Professor Hickie has been strikingly inconsistent in his position on multiple issues, including the relationship between electroconvulsive therapy (ECT) and retrograde amnesia (RA) – loss of long-term memory. RA is an acknowledged side effect of ECT but opinions are polarised about how persistent it can be.[1] [2]

 

Hickie was a co-author of an article published in January 2010 in the Journal of Affective Disorders titled Electroconvulsive therapy-induced persistent retrograde amnesia: could it be minimised by ketamine or other pharmacological approaches? The article appropriately acknowledged that ‘available evidence indicates that ECT is objectively associated with persistent RA, and both clinicians and patients report that RA is distressing for patients’. It outlined several hypotheses for the relationship but stated that ‘The mechanism for ECT-induced RA is unclear’.[3]

 

The paper concluded that the problem of ECT-induced RA was ‘common, significant and undesirable’ and that it warranted exploration of other treatment methods. These potential treatment methods included experimenting with simultaneous administration of ketamine or other pharmacological approaches to see if this prevented the memory loss:

"selective physical treatments for depression, such as transcranial magnetic stimulation, magnetic seizure therapy, vagus nerve stimulation, and transcranial direct current stimulation [might] achieve an antidepressant effect without the cognitive side effects of generalised physical therapies such as ECT. However, it is possible that there is a simpler solution to the problem, and trialling ketamine for reducing ECT-induced RA would seem a cogent next step forward".[4]

 

Eleven months later, however, Hickie emphatically told The Age that the findings of a newly published review article[5] critical of the long-term effects of ECT ‘were “ridiculous” and that while previously it was presumed that ECT caused memory loss, advances in brain imaging had shown the patient’s depression was often to blame’. Furthermore, he asserted: ‘This review is completely out of step with the last decade of systematic neuroscience and related clinical studies’.[6]

 

There were no Eureka-moment breakthroughs in brain imaging of people with depression between November 2009 (when the 2010 article was resubmitted and accepted) and December 2010 that could account for Hickie’s massive about-turn. In addition, Hickie’s co-authored article did not suggest that persistent ECT-induced memory loss was caused by patients’ depression.

 

Hickie is not alone, in that many psychiatrists support the use of ECT, and it is not unusual for experts to disagree with findings of published articles. However, the ECT amnesia link as ‘ridiculous’, contradicting the fundamental basis of his own recent paper, is astonishing behaviour.

References

[1]    Meeter, M, Murre, J. M. J., Janssen, S. M. J., Birkenhager, T., & van den Broek, W. W. (2011). Retrograde amnesia after electroconvulsive therapy: A temporary effect? Journal of Affective Disorders, 132(1-2) 216–222. doi:10.1016/j.jad.2011.02.026. https://www.sciencedirect.com/science/article/pii/S0165032711000802 (accessed 27 July 2020).

[2]    Read J, & Bentall R (2010). The effectiveness of electroconvulsive therapy: a literature review. Epidemiologia e Psichiatria Sociale, 19(4), 333-347. http://psychrights.org/Research/Digest/Electroshock/2010ReadBentallElectroshockReview.pdf (accessed 27 July 2020).

[3]    Gregory-Roberts, E. M., Naismith, S. L., Cullen, K. M., & Hickie, I. B. (2010). Electroconvulsive therapy-induced persistent retrograde amnesia: could it be minimised by ketamine or other pharmacological approaches? Journal of Affective Disorders, 126(1-2), 39-45. https://www.sciencedirect.com/science/article/abs/pii/S0165032709005254 (accessed 11 December 2020)

[4]    Gregory-Roberts, E. M., Naismith, S. L., Cullen, K. M., & Hickie, I. B. (2010). Electroconvulsive therapy-induced persistent retrograde amnesia: could it be minimised by ketamine or other pharmacological approaches? Journal of Affective Disorders, 126(1-2), 39-45. https://www.sciencedirect.com/science/article/abs/pii/S0165032709005254 (accessed 11 December 2020)

[5]    Read J, & Bentall R (2010). The effectiveness of electroconvulsive therapy: a literature review. Epidemiologia e Psichiatria Sociale, 19(4), 333-347. http://psychrights.org/Research/Digest/Electroshock/2010ReadBentallElectroshockReview.pdf (accessed 27 July 2020).

[6]    Stark, J (2010). Call for ban on shock therapy The Age, December 19.  https://www.theage.com.au/national/victoria/call-for-ban-on-shock-therapy-20101218-191e2.html (accessed 5 December 2020).