Electroconvulsive Therapy, with Clozapine, Shows Promise for Patients with Treatment-Resistant Schizophrenia

Electroconvulsive Therapy, with Clozapine, Shows Promise for Patients with Treatment-Resistant Schizophrenia

Posted: September 16, 2014

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Among people with schizophrenia, one-fifth to one-third do not respond to antipsychotic medications. Studies have shown that in this group of “treatment-resistant” patients, up to 70 percent do not experience an alleviation of their symptoms, even from clozapine. Researchers have long been seeking an alternative, or supplemental, treatment to help more effectively treat symptoms of psychosis.

A new study published online August 26th in The American Journal of Psychiatry, involving five NARSAD Grantees from Zucker Hillside Hospital in Glen Oaks, New York, shows that electroconvulsive therapy (ECT) combined with treatment with clozapine, can reduce the severity of psychosis in treatment-resistant patients. ECT involves passing electrical current through the brain to induce a seizure that somehow leads to an improvement in brain function. Modern ECT has been modified from the sort used in the middle part of the 20th century, with different waveforms, seizure thresholds, and electrode placements developed to reduce the possibility of memory loss and negative side effects of earlier ECT.

The new study led by Georgios Petrides, M.D., and including Foundation Scientific Council members Nina Schooler, Ph.D., (1998 NARSAD Distinguished Investigator Grantee) and Anil Malhotra, M.D., (three-time NARSAD Grantee) along with former NARSAD Grantees Chitra Malur, M.D., Raphael Braga, M.D., Terry Goldberg, Ph.D., and other colleagues, involved a group of 39 patients with treatment-resistant schizophrenia. Over eight weeks, 19 patients took clozapine only, and 20 patients were given clozapine plus ECT treatment. Those receiving ECT had three sessions per week for the first four weeks, then two sessions per week for the last four weeks.

The researchers report that ECT reduced symptoms of psychosis by at least 40 percent in half of the patients receiving ECT (n = 10) at the end of the eight weeks. None in the clozapine-only group showed this level of improvement in symptoms. Significant improvement in the symptoms between the two groups emerged by week three and was maintained throughout the rest of the trial.

At the end of the initial eight weeks, the clozapine-only group was then given ECT as well. Half of this group (n = 9) also showed a pronounced decrease in psychosis symptoms. “These are among the highest response rates ever recorded in this patient population,” the researchers wrote. The treatment was also deemed safe, with only mild side effects.

Future studies will have to probe how long these improvements persist and whether maintenance treatments would be required, as is done when ECT is used to treat resistant depression. If larger studies bear out the safety and efficacy findings, the addition of ECT may significantly expand the options for patients with treatment-resistant schizophrenia.

Read the abstract of this research paper.

To learn more about this research, visit the Schizophrenia Research Forum.