- In treatment-resistant schizophrenia (TRS), the addition of electroconvulsive therapy (ECT) to clozapine (e.g., Clozaril) yielded medium to large effects on symptoms compared with clozapine alone, according to a meta-analysis.
- Memory impairment and headache occurred with ECT but were infrequent and generally mild and transient.
Why this matters
- The study is the largest meta-analysis of ECT supplementation of clozapine in TRS.
- Unlike previous meta-analyses, this study included Chinese studies that are not readily available.
- Meta-analysis of 18 randomized controlled trials (RCTs) evaluating the efficacy and safety of the ECT-clozapine combination for TRS.
- Funding: None disclosed.
- The ECT-clozapine combination (n=384) had superior (moderate to large) effects on symptoms of TRS vs clozapine alone (n=355) in terms of:
- early symptomatic improvement (1-2 weeks): standardized mean difference (SMD), −0.54; I2, 77%; P=.002; 8 RCTs;
- post-ECT assessment (4-12 weeks): SMD, −0.88; I2, 86%; P=.0001; 10 RCTs; and
- endpoint assessment after follow-up post-ECT (1-10 weeks): SMD, −1.44; I2, 95%; P<.00001 rcts.>
- ECT-clozapine combination vs clozapine alone often showed:
- memory impairment (risk ratio [RR], 16.10; I2, 0%; P<.0001 number needed to harm and>
- headache (RR, 4.03; I2, 0%; P=.005; NNH, 8).
- Significant heterogeneity in results.
Coauthored with Chitra Ravi, MPharm