Effect of the 2011 FDA Warning for Citalopram on EKG Monitoring, Antidepressant Prescriptions, and Health Care Utilization

Abstract

Introduction: Late-life depression (LLD) is a serious public health problem with estimated prevalence ranging from 1.8-25 percent in selected groups. LLD is known to negatively impact cognition both acutely and at follow up, even after remission of mood symptoms with antidepressant medications. Up to 50% conversion rate to dementia has been reported during long term follow up of patients with LLD. Electroconvulsive therapy (ECT), the most efficacious treatment for LLD, can be associated with detrimental effects on cognition. Some studies have demonstrated a pro-cognitive effect of non-convulsive electrical and magnetic brain stimulation interventions among patients with dementia. Methods: We conducted a systematic review of peer-reviewed literature on the effect of ECT and other brain stimulation interventions on the nature and course of cognitive function in patients with LLD. Search included three databases (EMBASE, Ovid Medline, and PsycINFO) through Feb 2014 and included the references of retrieved publications. The search limited age to 65 and over, human, English language and peer-reviewed journals. Results: A total of 3,972 publications were identified; 294 were reviewed and 36 met the inclusion criteria: 34 publications pertaining to ECT and 2 pertaining to repeated transcranial magnetic stimulation (rTMS). The majority of these publications report some transient post-ictal and inter-ictal confusion associated with ECT but no long-term (i.e., 6 months or longer) deleterious effects on cognition. Instead, long-term cognitive outcomes with ECT have been reported as either not changed or improved. rTMS studies reported no acute changes in cognition. Conclusions: Published literature on brain stimulation interventions in LLD is mainly limited to ECT. This literature suggests that deleterious effects of ECT on cognition in older adults are limited and transient. There is not enough evidence to characterize the long-term deleterious effects of ECT on cognition in LLD or the effects of other brain stimulation techniques on cognition in LLD.