Evaluation of donepezil and rivastigmine administration on the cognitive deficits induced by electroconvulsive therapy: A randomized, double-blind clinical trial

Background
Although several medical interventions have been used to reduce the cognitive side effects of electroconvulsive therapy (ECT), no specific drug has been yet identified to solve this problem.

Objectives
Because donepezil and rivastigmine are used to reduce the cognitive deficits in Alzheimer’s patients, this study evaluated the effectiveness of these drugs on cognitive function in patients treated with ECT.

Material and methods
This randomized, double-blind clinical trial was performed on 60 patients with various mental disorders who were undergoing ECT as non-hospitalized patients or in the psychiatric ward of Golestan Hospital in Ahvaz, Iran. The subjects were divided into 3 groups of patients, receiving either donepezil, rivastigmine or a placebo. The Mini-Mental State Examination scores (MMSE) of the patients were evaluated before the initial ECT session, after the middle ECT session and after the final ECT session; the collected data were then analyzed using SPSS software version 22.

Results
The patients consisted of 25 females and 35 males at a mean age of 32.65 ± 8.81 years. The mean total number of ECT sessions was 7.41 ± 1.86 (p = 0.357). The mean of MMSE scores before the initial ECT session was 26.41 ± 1.35 in all patients, without a significant difference between the groups (p = 0.387). The mean of MMSE scores after the middle ECT session was 26.70 ± 1.41 for the donepezil group, 26.25 ± 1.29 for the rivastigmine group and 24.75 ± 2.07 for the placebo group; the MMSE scores of the placebo group were significantly lower (p = 0.003). Also, the mean of MMSE scores after the final ECT session was 26.75 ± 1.29 for the donepezil group, 26.40 ± 1.31 for the rivastigmine group and 24.50 ± 1.84 for the placebo group, which shows significantly lower scores in the placebo group (p < 0.001). The correlation between age and MMSE score after the ECT sessions was negatively correlated in the donepezil group.

Conclusions
The mean of MMSE scores in the placebo group was significantly lower than the donepezil and rivastigmine groups in the middle of the ECT and after the final ECT sessions.