Effects of Celecoxib on Electroconvulsive Therapy-Induced Cognitive Impairment in Patients With Major Depressive Disorder: A Pilot, Double-Blind, Placebo-Controlled Trial

Abstract

Cognitive impairment, an important side effect of electroconvulsive therapy (ECT), may be related to the release of prostaglandins in the brain. Cyclooxygenase-2 (COX-2), constitutively expressed in the CNS, has a functional role in glutamate-mediated learning and memory. The goal of this pilot, double-blind, placebocontrolled trial was to evaluate the effects of the selective COX-2 inhibitor celecoxib on the adverse cognitive effects of ECT. Twenty patients diagnosed with the major depressive disorder for which ECT was indicated as a treatment for their current episode randomly received either celecoxib (200 mg orally twice a day, a total dose of 400 mg/day) or placebo. All patients underwent the same protocol for anesthesia and ECT procedures. The patients received celecoxib or the placebo for the whole period of ECT treatment, starting the day before ECT and continuing until the sixth (last) session of ECT. The Wechsler Mental Scale-III (WMS-III), the Mini-Mental Scale Examination (MMSE), and Stroop Color test were used to assess cognition before the first session and after the first, third and sixth sessions of ECT. Hamilton rating scale for depression was also used for the assessment of depression before and after the trial. Our data showed that celecoxib group did not have significant improvement in cognition based on WMS-III or MMSE scores. There was an improvement in the Stroop Color test but not statistically significant. Our results demonstrated that although celecoxib was well tolerated in patients undergoing ECT, it did not improve related cognitive impairment. Clinical trial registration number: IRCT201201247202N2. CNS, central nervous system; COX-2, Cyclooxygenase-2; DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision; ECT, electroconvulsive therapy; ECS, electroconvulsive shocks; HAM-D, Hamilton rating scale for depression; LTP, long term potentiation; MDD, major depressive disorder; MMSE, Mini-Mental State Examination; NSAIDs, nonsteroidal anti-inflammatory drugs; WMS-III, Wechsler Memory Scale-III.