Nicardipine improves the antidepressant action of ECT but does not improvecognition

Introduction: Cognitive impairment, the most important adverse effect of el ectroconvulsive therapy (ECT), may involve elevated intracellular calcium i on signaling. Animal research suggests that calcium channel-blocking agents , which attenuate excessive intracellular calcium activity, may reduce cogn itive dysfunction caused by ECT. Method: The lipid-soluble calcium channel- blocking drug nicardipine or matching placebo were randomly assigned to 26 patients with major depressive disorder receiving ECT. A rater blind to the experimental condition administered the Hamilton Depression Rating Scale, the Montgomery-Asberg Depression Rating Scale, the Beck Depression inventor y, the Mini-Mental State Examination and a comprehensive battery of neurops ychological tests prior to ECT, at the completion of ECT, and 6 months afte r ECT completion. Results: Compared with patients receiving placebo, patien ts taking nicardipine had significantly lower scores on the Hamilton and Mo ntgomery-Asberg but not the Beck Depression rating scale scores at the comp letion of ECT. There were no differences between placebo and nicardipine gr oups in depression scores 6 months after ECT. Cognitive function declined o ver the course of ECT and improved over the next 6 months in both groups, b ut changes were statistically significant for only two subtests on the neur opsychological battery. Changes in Mini-Mental State Examination scores wer e small and were not significant at any point. There were no significant di fferences between nicardipine and placebo treated groups in any assessment of cognition. Discussion: Standard approaches to ECT in younger patients wi thout preexisting neurological impairment do not produce cognitive side eff ects of sufficient severity for calcium channel-blocking agents to reduce t hese side effects demonstrably. Studies of treatments for cognitive impairm ent should be conducted in patients with risk factors for more severe cogni tive impairment such as geriatric patients or patients with a history of in terictal delirium during previous treatment with ECT. A possible effect of nicardipine in enhancing the antidepressant action of ECT requires further investigation in a study designed to test this action.