From the Guidelines
Donepezil is effective for managing memory loss in patients with Electroconvulsive Therapy (ECT), and it should be prescribed at a starting dose of 5 mg once daily, which may be increased to 10 mg daily after 4 weeks if needed and tolerated. The medication works by increasing acetylcholine levels in the brain, which helps improve cognitive function 1. According to the guidelines for managing Alzheimer's disease, donepezil produces clinically meaningful improvements of cognitive and global function in patients with mild to moderate Alzheimer’s disease 1.
Key Considerations
- Donepezil is not hepatotoxic, and adverse effects are mild, including nausea, vomiting, and diarrhea, which can be reduced by taking the medication with food 1.
- Some patients may exhibit an initial increase in agitation, which subsides after the first few weeks of therapy 1.
- The efficacy of donepezil has been apparent over up to 4.9 years, but its long-term effect is unknown 1.
- Common side effects of donepezil include diarrhea, nausea, and vomiting, with diarrhea and nausea being reported most frequently 1.
Clinical Implications
- Donepezil may help reduce the severity and duration of ECT-related cognitive effects, particularly for patients undergoing multiple ECT sessions or those with pre-existing cognitive vulnerabilities.
- Patients with cardiac conditions should use donepezil cautiously, as it may cause bradycardia.
- The medication should be taken in the evening before bedtime to minimize side effects, and treatment often begins shortly before or during the ECT course and may continue for several weeks to months afterward, depending on the severity of cognitive symptoms.
From the Research
Effectiveness of Donepezil for Memory Loss in Patients with Electroconvulsive Therapy (ECT)
- The effectiveness of donepezil in treating memory loss in patients undergoing ECT has been investigated in several studies 2, 3, 4.
- A systematic review found that cholinesterase inhibitors, including donepezil, may be effective in reducing cognitive adverse effects of ECT, with significant improvements in immediate memory and recovery of personal memory 2.
- However, a randomized controlled trial found that donepezil (10 mg/day) did not improve memory outcomes after ECT, with no significant difference between the donepezil and placebo groups 3.
- Another study found that donepezil had a therapeutic and prophylactic benefit on cognition in patients undergoing ECT, speeding up the improvement of general memory and working memory during ECT 4.
- The optimal dosing, titration, and duration of therapy for donepezil in patients undergoing ECT are still unclear and require further study 2.
Comparison with Other Cholinesterase Inhibitors
- A network meta-analysis found that donepezil 10 mg had the greatest effect on cognition in people with vascular cognitive impairment, but at the cost of adverse effects 5.
- Galantamine 16 to 24 mg was also found to have a beneficial effect on cognition, although the size of the change was unlikely to be clinically important 5.
- Rivastigmine 3 to 12 mg daily had a less certain effect on cognition, with low-certainty evidence suggesting little to no effect 5.