Combined electroconvulsive therapy and clozapine in schizophrenia

Abstract

Although clozapine is effective in treating about one third to one half of schizophrenic patients refractory t0 conventional antipsychotie agents, there is still a substantial number of schizophrenic patients who do not respond adequately to clozapine. Treatment options for such patients currently are limited; supplementing clozapine with a course of electrocnnvulsive therapy (ECT) has been suggested as one possible approach. Specifically, investigators have questioned the utility, safety, and efficacy of ECT augmentation in combination with clozapine in treatment-refractory schizophrenia. To assess the efficacy and safety of this combination, we evaluated the effects of combining clozapine and ECT in 14 schizophrenic inpatients (SADS/RDC and DSM-III-R). All these patients were on treatment with clozapine at the time that ECT was considered. All these patients had significant symptomatology despite clozapine treatment; the range of symptoms included disorganization, positive symptoms, catatonia, and negative symptoms. The sample consisted of nine male and five female patients. Bilateral ECT was utilized in all patients; the number of treatments ranged from 8-18. The dose of clozapine ranged from 200-800 mg/day. Five patients showed marked and sustained clinical improvement, five patients showed transient improvement followed by relapse, and four patients showed no response. One patient of the group that showed u'ansient improvement followed by relapses received maintenance ECT but relapsed despite maintenance ECT, Except fnr one patient who experienced significant tachycardia (which continued after discontinuation of ECT), we saw no adverse effects in connection with the combination of ECT and clozapine. Supplementing clozapine with a course of bilateral ECT appears to be safe and is effective in some patients with refractory schizophrenia. More systematic trials are indicated.