Maintenance ECT Shows Efficacy, Few Side Effects in Preventing Schizophrenia Relapse

Maintenance electroconvulsive therapy (M-ECT) may be effective in preventing relapse in individuals with schizophrenia while causing minimal cognitive side effects, according to a study recently published in Psychiatry Research.

Study researchers included 37 publications involving adults receiving M-ECT between 1990 and 2016. These studies were selected according to PRISMA guidelines. One randomized controlled trial showed a combination of medication and M-ECT to be significantly more effective than medication alone for symptoms (P =.0008) and time until relapse (P =.0005), although another trial showed worsened negative symptoms (P =.003) that were nevertheless better than baseline. This second trial also demonstrated a 54% difference in rate of relapse among patients treated with both medication and M-ECT, compared with 15% in patients with medication alone. Cross-sectional examination revealed no significant difference in adverse cognitive side effects between patients treated with M-ECT and those not receiving it.

M-ECT’s side effects typically included light cognitive impairment and transient memory loss, but rarely did it lead to discontinuation of ECT. One randomized controlled trial included a thorough cognitive assessment of frontal cortex functions including memory and attention in both M-ECT-treated and untreated patients, and showed no difference between the groups. One trial showed verbal and visual memory to improve among those treated with M-ECT, though their total scores turned out to be lower than those treated only with medication.

Although an initial course of ECT is used to treat acute symptoms and induce remission in individuals with schizophrenia, antipsychotic continuation is used to prevent relapse. Acute ECT has cognitive side effects. However, the performance of individuals with schizophrenia is normally between 1 and 1.8 standard deviations below healthy controls, and ECT or M-ECT have not been shown to exacerbate this performance. Still, a thorough review of M-ECT use was needed to examine possible side effects and help guide clinical applications.

The study researchers conclude that “[relapse] after discontinuation of ECT in patients with schizophrenia is significant. M-ECT could provide a modality for relapse prevention, in conjunction with continued antipsychotic treatment. However, cognitive side effects should be monitored with prolonged ECT treatments.”

Reference

Ward HB, Szabo ST, Rakesh G. Maintenance ECT in schizophrenia: a systematic review [published online March 20, 2018]. Psychiatry Res. doi: 10.1016/j.psychres.2018.03.033