Autobiographical memory and electroconvulsive therapy: do not throw out the baby

Abstract

Retrograde amnesia for autobiographical information is the most critical adverse effect of electroconvulsive therapy (ECT). Much, if not most, modern research demonstrating long-term autobiographical amnesia after ECT has used either the Columbia University Autobiographical Memory Interview (CUAMI) or the short form of this scale (CUAMI-SF). Semkovska and McLoughlin claimed that studies using these instruments should be dismissed and the findings ignored owing to a lack of normative data, as well as concerns about the reliability and validity of these instruments. In this commentary, the development and use of these scales is reviewed. It is shown that Semkovska and McLoughlin's critique is factually incorrect, as normative data were simultaneously collected in virtually all studies using these instruments. Furthermore, there is substantial evidence supporting the reliability and validity of these scales. Indeed, these instruments are the only neuropsychological tests repeatedly shown to covary with patient self-evaluations of ECT's effects on memory and have repeatedly demonstrated long-term differences in the magnitude of amnesia as a function of ECT technique. Findings with the CUAMI and CUAMI-SF provide key evidence regarding ECT's adverse cognitive effect profile. It is inaccurate and inadvisable to continue to deny that ECT can exert long-term adverse effects in this domain.

Figures

Figure 1

Scores of healthy controls and four ECT groups on the CUAMI at immediate postECT relative to baseline. Scores at postECT (or after 4 weeks for controls) and baseline were standardized relative to the distribution in patients at baseline. The baseline normalized scores were then subtracted from the postECT normalized scores. Negative values reflect greater inconsistency. Pair-wise comparisons showed that all groups significantly differed from each other, except healthy controls and patients who received ultrabrief RUL ECT. Data, previously unpublished, are from Sackeim et al.

Figure 2

Standardized scores on the CUAMI for the ECT groups at multiple postECT time points. Scores were adjusted for the rate of inconsistency in healthy controls at immediate postECT. Thus, a score of zero reflects the extent of inconsistency in the healthy controls. Patients randomized to brief pulse ECT or who received crossover ECT had marked and persistent deficits relative to both controls and patients treated with ultrabrief stimuli. Figure is from Sackeim et al.