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Combined use of clozapine and ECT: a review

Published online by Cambridge University Press:  20 February 2015

Sandeep Grover ,
Nandita Hazari  and
Natasha Kate
Sandeep Grover*
Affiliation:
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Nandita Hazari
Affiliation:
Department of Psychiatry, KEM Hospital, Mumbai, India
Natasha Kate
Affiliation:
Department of Psychiatry, KEM Hospital, Mumbai, India
*
Dr. Sandeep Grover, Assistant Professor, Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India. Tel: +0091 172 2756807 (O); Fax: +91 172 2744401; 2745078; E-mail: [email protected]
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Abstract

Objective

This paper aims to review the available evidence for the use of clozapine and electroconvulsive therapy (ECT) in combination.

Methodology

Electronic searches were carried out to identify reports describing the combined use of clozapine and ECT.

Results

Forty reports including 208 patients were identified. The majority of reports were in the form of case reports and case series, with few retrospective and open-label studies. The majority of patients were aged between 18 and 65 years and diagnosed with schizophrenia or schizoaffective disorder. Most of the patients refractory to clozapine were started on ECT as an augmentation therapy; however, in some reports, both ECT and clozapine were started concurrently, and in few cases clozapine was started after ECT. In terms of effectiveness, 37.5–100% patients improved in short-term, and sustained long-term improvement (3 weeks to 24 months) was described in few studies. In terms of the side-effect profile, five patients each had delirium and tachycardia and only four patients were described to have prolonged seizures. Overall, the combination was considered effective and safe.

Conclusion

There is evidence for the effectiveness and safety of the clozapine–ECT combination and it should be used in patients with treatment-resistant schizophrenia who do not respond to clozapine.

Keywords

augmentationclozapineECT
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 27 , Issue 3 , June 2015 , pp. 131 - 142
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Copyright
© Scandinavian College of Neuropsychopharmacology 2015 

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