Hybrid ECT (Includes Subconvulsive Treatments) For Schizophrenia: Study From China

Out on PubMed from investigators in China, is this study:

The efficacy and acceptability of hybrid electroconvulsive therapy compared with standard electroconvulsive therapy for schizophrenia patients: A parallel-group, double-blind, randomized, controlled trial.

Li J, Deng WF, Xu SX, Jiang ZY, Rong H, Kong XM, Xie XH.Brain Stimul. 2021 May 4;14(3):737-739. doi: 10.1016/j.brs.2021.04.017. Online ahead of print.PMID: 33962078

The pdf is here.

And from the text:

Previous studies have demonstrated that electroconvulsive therapy (ECT) augmentation of antipsychotics is highly effective for treatment-resistant schizophrenia patients or those who require a rapid response [1]. Despite the effectiveness of ECT, its use is limited primarily due to adverse events (AEs) [2,3], which may be related to ECT dosing, seizures or electrode placement [3,4]. Notably, a study demonstrated that nonconvulsive electrotherapy (NET) or low-charge electrotherapy (LCE) may have similar antidepressant effects to ECT but without serious AEs in a sample of patients with depression [5]. We conducted a pilot randomized controlled trial (RCT) and found that schizophrenia patients in the LCE group showed significantly fewer AEs compared with those in the ECT group [6]. However, our subsequent in-house data suggested that the initial remission may be slower in the LCE group than in the ECT group, and the patients in the LCE group required more treatment sessions. To combine the advantages of ECT (rapid remission) and LCE (fewer side effects), we designed a simple but novel energy set strategy for ECT, termed hybrid-ECT (HECT), for schizophrenia patients, in which the first four sessions use ECT (Phase 1) for rapid remission and the subsequent sessions use LCE (Phase 2) to reduce side effects, similar to the depression version [7]. To examine the efficacy and acceptability of HECT compared with standard ECT (all sessions were ECT) for schizophrenia patients, we performed the present RCT.

Bitemporal ECT or LCE sessions were performed three times a week with a spECTRUM 5000Q ECT instrument (MECTA Corporation, OR, USA). Dose titration to determine the seizure threshold (ST) was performed at the first ECT session. The charge dose for subsequent ECT sessions was set at 1.5 * ST. For LCE sessions, the energy was set at 0.5 * ST, regardless of whether seizures were induced.

This is a novel study from China in which patients were randomized to either standard ECT or four standard ECT treatments followed by non-convulsive "low-charge electrotherapy" in the hybrid group. There were 30 patients total in the study and results failed to find a statistically significant difference in efficacy, but better cognitive tolerability in the hybrid group. The authors note that the study was underpowered to detect an efficacy difference.

While interesting, this study begs the question of the efficacy of subconvulsive treatments (very limited data) and related ethical issues.

Worth a read, ~10 minutes.