Lithium during maintenance electroconvulsive therapy: Secondary neuropsychological outcomes from the open-label PRASED randomized controlled trial
In brief
Lithium added to maintenance electroconvulsive therapy showed no cognitive disadvantage
Over six months, 50 patients taking lithium and 46 not taking it had similar cognitive trajectories during maintenance electroconvulsive therapy; performance improved in both groups in all tested domains except verbal fluency. Lithium levels were not linked to test results, but this secondary analysis does not settle cognitive effects beyond six months.
- Journal
- Journal of affective disorders (Q1)
- Published
- 7 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Liese Van den Eynde, Kristof Vansteelandt, Jasmien Obbels, Nathalie Denayer, Shauni Verspecht, Kaat Hebbrecht, et al.
- PMID
- 42843471
- DOI
- 10.1016/j.jad.2026.122596
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 9 October 2026): Lithium adjunct during maintenance ECT
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.