Combined Electroconvulsive-Clozapine Therapy

Abstract

We reviewed 36 reported psychiatric patients who were treated with a combination of electroconvulsive therapy (ECT) and clozapine. The indication of the ECT-clozapine treatment was resistance to classical antipsychotic agents, clozapine, or ECT alone. Sixty-seven percent of the patients benefited from the combined treatment. In most of the patients, the combined treatment was safe and well tolerated. Adverse reactions occurred in 16.6% of the patients and included prolonged ECT-induced seizures (one case), supraventricular (one case) and sinus tachycardia, and blood pressure elevation. It seems that combined ECT-clozapine treatment is effective and safe. This strategy may be a therapeutic option in treatment-resistant patients.

The maintenance of modified electroconvulsive therapy combined with risperidone is better than risperidone alone in preventing relapse of schizophrenia and improving cognitive function

“…Previous case reports and small-scale open trials have demonstrated that maintenance ECT is effective in drug-resistant schizophrenia 17,18 . Chanpattana and coworkers have indicated that compared with maintenance ECT alone or flupentixol alone, the combination of maintenance ECT and flupentixol is more effective in preventing the relapse of schizophrenia 19 .…”

Efficacy of electroconvulsive therapy augmentation for partial response to clozapine: a pilot randomized ECT – sham controlled trial

“…This is pointed out by some reviewers who observed that the lack of response to ECT may related to low clozapine oral doses 30 and that the majority of published studies on the efficacy of ECT augmentation strategy for patients with partial response to clozapine did not report their clozapine doses or plasma levels 31 .…”

Treatment–Refractory Schizophrenia

“…[144][145][146][147][148][149][150][151] However, it is important to note that patients who get ECT are the more severe patients, and they generally get ECT after most other interventions have failed. Hence, when and if improvement is eventually associated with ECT, the possibility of a regression to the mean of the most severe patients cannot be ruled out.…”