Lithium during maintenance electroconvulsive therapy: Secondary neuropsychological outcomes from the open-label PRASED randomized controlled trial.

BACKGROUND

Lithium is commonly used for relapse prevention after successful electroconvulsive therapy (ECT). However, the combination of lithium and ECT has warranted caution in clinical practice due to concerns about cognitive tolerability, while evidence remains inconclusive.

OBJECTIVE

To evaluate the neuropsychological effects of maintenance ECT (M-ECT), with and without lithium, in patients with major depressive disorder (MDD) across all ages.

METHODS

The Preventing Relapse After Successful Electroconvulsive therapy for Depression (PRASED) study was a multicenter, open-label, randomized controlled trial. Patients who achieved remission after an acute ECT course for MDD were randomized to receive symptom driven M-ECT and maintenance pharmacotherapy with or without adjunctive lithium. In this secondary outcome analysis, neuropsychological functioning was assessed repeatedly over six months using a comprehensive test battery covering global cognition, memory, attention, fluency, processing speed and subjective memory complaints. Linear mixed-effects models were applied to examine group differences in cognitive trajectories over time and associations between serum lithium levels and cognitive outcomes.

RESULTS

No significant differences in cognitive trajectories were observed between the lithium (n = 50) and non‑lithium (n = 46) group. Neuropsychological performance improved over time in both groups across all cognitive domains except verbal fluency. Serum lithium levels were not associated with neuropsychological performance.

CONCLUSION

Lithium addition during M-ECT was not associated with impaired objective or subjective neuropsychological functioning. These findings support the neuropsychological tolerability of concurrent lithium and ECT use in the maintenance phase and may help guide treatment decisions regarding relapse prevention following successful ECT.