Electroconvulsive Therapy and Posttraumatic Stress Disorder: First Experience With Conversation-Based Reactivation of Traumatic Memory Contents and Subsequent ECT-Mediated Impairment of Reconsolidation.

Mappe: ECT/2014 a


Maximilian Gahr, M.D.

Carlos Schönfeldt-Lecuona, M.D. Manfred Spitzer, M.D.

Heiko Graf, M.D.

Dept. of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm, Germany

To the Editor: Strong and recurrent activation of traumatic memory contents (TMC) was suggested to be an essential pathophysiologic mechanism in posttraumatic stress disorder (PTSD). 1 Thus, reduced activation or availability of this particular TMC could result in amelioration of PTSD core symptoms.

Recently demonstrated efficacy of ECT in the treatment of PTSD 3 might be due to impaired reactivation of TMC. Consolidated memory contents are suggested to be destabilized during their retrieval, and thus, sensitive for modifications at the time of their current recall and reconsolidation. 4 Hence, ECT might be most effective immediately after an active (conversation-based) confrontation with the TMC

a conversation-based reactivation of this particular TMC was performed immediately before ECT (duration of 10 minutes). The patient was advised to remember the accident and to describe his particular memories verbally (average time between end of memory reactivation and application of etomidate: 10 minutes)

The patient reported improvement of PTSDsymptoms accompanied by a more clear improvement of depression. PTSD-symptoms related to the accident subsided completely and though PTSD-symptoms persisted, they were not accompanied by memories related to the accident.

Evidence for the possible efficacy of ECT in the treatment of therapy-refractory PTSD by specific elimination of one particular TMC. However, PTSD symptoms did not subside completely. This is partly explained by the fact that the patient´s PTSD was due to multiple traumas.