Donepezil Memory Preservation Post ECT

Electroconvulsive therapy (ECT) is a method used to treat a variety of psychiatric
conditions. An electrical current is distributed throughout the brain (Lisanby 2007) inducing
seizure activity in a controlled setting using neuromuscular blocking agents (Mirzakhani
2012) while the patient is under anesthesia (Deiner 2009). ECT is approved by the Food and
Drug Administration (FDA) for the following conditions: unipolar and bipolar depression,
manic and mixed states in bipolar disorder, schizophrenia, schizoaffective disorder,
schizophreniform disorder and catatonia (FDA executive summary). ECT is often used after
trials of psychotropic medications have failed (Kellner 2012).

Electroconvulsive therapy (ECT) is commonly associated with cognitive side effects that range
from anterograde and retrograde amnesia to issues with executive function, attention and
declines in information processing. Problems with autobiographical memory and recall for new
information appear to be affected the most. In addition, data suggests that the loss of
memory of autobiographical events may persist as long as six months. These issues may cause
patient adherence problems and potential relapses into previous psychiatric conditions.

Donepezil is an acetylcholinesterase inhibitor indicated for Alzheimer's Dementia and has
been shown to slow the progressive decline in cognition and memory in Alzheimer's Dementia.
It is hypothesized that donepezil will help to preserve memory and minimize the decline in
memory that is associated with the administration of ECT.

This study aims to determine if donepezil can minimize deficiencies in autobiographical
memory 4-5 weeks after ECT treatment has been started.

Inclusion Criteria:

- Diagnosis of major depressive disorder, anxiety disorders, bipolar depression who are
receiving right unilateral ECT will be included.

Exclusion Criteria:

- Patients with previous use of alcohol or illicit drugs within seven days of
randomization will be excluded. Preexisting unstable cardiovascular disease including
uncontrolled hypertension will be excluded. Patients with a documented allergy to
donepezil will also be excluded. Patients with axis I disorders (eg. schizophrenia,
schizoaffective disorder) other than major depressive disorder, anxiety disorders
and/or bipolar depression will be excluded. Patients on anticoagulant therapy or
chronic NSAID therapy will be excluded. Patients who are pregnant or wish to become
pregnant within one year from trial enrollment will also be excluded. Patients who
have received ECT within 6 months of enrollment will be excluded. Baseline Mini Mental
State Examination (MMSE) < 24 will be excluded.