and is included as an option for refractory BD in the algorithms of several published guidelines.1-6 A major concern regarding ECT as a treatment option is generally not whether it is effective but whether it is associated with long-term cognitive changes, particularly in various memory systems. The effect of ECT on memory continues to be studied,7-17 discussed and debated.18-24 Perhaps the most controversial issue is whether ECT results in long-term (usually defined as greater than 6 months) changes in anterograde or retrograde memory performance; this is also an issue of clinical relevance.