(Sept. 26, 2020)-ECT and Clozapine: More Data in Treatment-Resistant Schizophrenia

Out on PubMed, from researchers in the UK, Ireland, and Israel is this study:Augmentation of clozapine with ECT: a retrospective case analysis.

Lally J, Breese E, Osman M, Hua Sim C, Shetty H, Krivoy A, MacCabe JH.Acta Neuropsychiatr. 2020 Sep 24:1-22. doi: 10.1017/neu.2020.32. Online ahead of print.PMID: 32967745
The abstract is copied below:

Objective: We sought to assess the effectiveness of clozapine augmentation with ECT (C+ECT) in patients with clozapine-resistant schizophrenia.

Methods: We conducted a retrospective review of electronic health records to identify patients treated with C+ECT. We determined the response to C+ECT and the rate of rehospitalisation over the year following treatment with C+ECT.

Results: Forty-two patients were treated with C+ECT over a ten year period. The mean age of the patients at initiation of ECT was 46.3 (SD=8.2) years (range 27-62 years). The mean number of ECTs given was 10.6(SD = 5.3)(Range 3-25) with the majority receiving twice weekly ECT. Seventy six percent of patients (n=32) showed a Clinical Global Impression improvement score (CGI-I) of≤3 (at least minimally improved) following C+ECT. The mean number of ECT treatments was 10.6 (SD = 5.3) (range 3-25) with the majority receiving twice weekly ECT. Sixty four percent of patients experienced no adverse events. Response to C+ECT was not associated with gender, age, duration of illness, or duration of clozapine treatment.Seventy five percent of responders remained out of hospital over the course of one-year follow up, while 70% of those with no response to C+ECT were not admitted to hospital. Three patients received maintenance ECT, one of whom was rehospitalised.

Conclusion: This study lends support to emerging evidence for the effectiveness of C+ECT in clozapine resistant schizophrenia. These results are consistent with the results of a meta-analysis and the only randomised controlled trial (RCT) of this intervention. Further RCTs are required before this treatment can be confidently recommended.

Keywords: Schizophrenia; clozapine; electroconvulsive therapy; psychosis; treatment-resistant.

This report adds to the evidence base for the effectiveness of an acute course of ECT in clozapine-resistant patients with schizophrenia on clozapine. The number of patients (3) who were prescribed maintenance ECT is strikingly low.

As I have noted previously, despite schizophrenia being the #1 ECT diagnosis worldwide, the scientific evidence base was not enough to convince either NICE or the FDA to fully endorse ECT for this indication. Thus, every bit of evidence is valuable.

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