Electroconvulsive Therapy May Prevent Symptomatic Relapse for Clozapine-Resistant Schizophrenia

Psychiatry Advisor Contributing Writer
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For patients with severe melancholic forms of depression or treatment-resistant depression, clinicians may consider electroconvulsive therapy, which consists of administering electric charges to create a controlled seizure in unconscious patients.
For patients with severe melancholic forms of depression or treatment-resistant depression, clinicians may consider electroconvulsive therapy, which consists of administering electric charges to create a controlled seizure in unconscious patients.
Researchers found that continuing, a tapered schedule of electroconvulsive therapy (ECT) treatments for patients with treatment-resistant schizophrenia who showed response to the combination of acute ECT and clozapine in a previous randomized controlled trial of ECT augmentation of clozapine was effective.

Electroconvulsive therapy (ECT) as a continuation strategy may be effective in preventing symptomatic relapse for clozapine-resistant patients with schizophrenia who have successfully completed an acute course of ECT, according to a study published in The Journal of ECT.  

A clinical challenge in ECT practice is the risk for relapse after a successful acute course of ECT treatment, particularly in patients with marked resistance to previous treatments. The current study evaluated the efficacy of a continuing, tapered schedule of ECT treatments for patients with treatment-resistant schizophrenia who showed response to the combination of acute ECT and clozapine in a previous randomized controlled trial of ECT augmentation of clozapine.

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Patients meeting the response criterion of 40% reduction in the Brief Psychiatric Rating Scale psychotic symptom subscale (BPRS-PS) after the randomized controlled trial (N=14) followed a tapered treatment schedule of 4 weekly ECT sessions, followed by 4 sessions given every 2 weeks and 2 sessions given monthly, for a total of 10 sessions.

Out of the 14 qualifying patients, 42.9% (n=6) completed the 6-month study of all 10 ECT continuation treatments, with the remaining 8 patients (57.1%) receiving 4 to 7 continuation treatments. At the time they stopped the continuation treatment, none of the patients had relapsed. Before the acute course of ECT treatments, the mean BPRS-PS score for the continuing ECT patients was 17.0 (±0.9), and their mean scores at continuation baseline were 7.7 (±0.9). At the end of the study, the mean BPRS-PS scores were 9.4 (±0.9) for all 14, and 9.6 (±1.0) for the 6 patients who completed the study. All 8 patients who received continuation ECT for less than 6 months expressed feeling well with no further need for the treatments, and could not continue due to practical reasons, primarily a lack of social support as outpatients.

Although the study was limited by the very small sample size, and further research is needed to confirm the findings, investigators concluded, “During the 6-month maintenance period, our patients sustained the gains achieved with the acute course of ECT, and no individual patient presented with clinically relevant worsening of symptoms. Moreover, the long-term use of ECT in this cohort was not associated with added adverse effects. In fact, some [patients] experienced some improvement in cognition during the study period. This is likely due to the progressively lower frequency of ECT sessions administered and, for some patients, the improved level of functioning and cooperation with cognitive testing.”

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Reference

Braga RJ, John M, Schooler NR, et al. Continuation electroconvulsive therapy for patients with clozapine-resistant schizophrenia: a pilot study [published online April 9, 2019]. J ECT. doi: 10.1097/YCT.0000000000000588