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 structures are involved in the pathophysiology of ECT-induced memory effects.
Financial Disclosure: Ms Donahue reported that she brought a malpractice suit alleging that unnecessary use and extent of bilateral ECT to achieve remission of her major depression in 1995 and 1996 resulted in significant retrograde amnesia. The lawsuit was settled out of court in 2000 with standards of practice agreed to by the defendant hospital and no direct financial remuneration to the plaintiff. Confidentiality regarding details of the settlement was required by the defendant.
This letter was shown to Dr Fink, who declined to reply on behalf of the authors. —ED.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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