Combined use of ECT and psychotropic drugs: Antidepressives and antipsychotics

Despite overall effectiveness of ECT and psychotropic drugs utilized separately in depressive illness and schizophrenic reactions, there are still a considerable number of patients in both diagnostical categories who are not responsive and treatment resistant. Efforts were spent in the past to combine both treatment approaches for these hard-core treatment resistant patients. This paper reviews previous investigations of the combined use of ECT and psychotropic drugs in the light of research methodology and theoretical framework behind their use. It concludes that although there is no theoretical justification, observed spectacular and long-lasting recoveries in some individual cases of chronic schizophrenia should compel the therapist to try ECT and psychotropic drug combinations. On the other hand, well designed blind controlled studies are needed to demonstrate the value of ECT and psychotropic drug combinations in obtaining faster recovery and longer remission in acute schizophrenia.It advocates the combination of ECT and antidepressives in depressive syndromes in spite of lack of controlled blind studies, merely because of recent theories which conceptualize the depression as a cholinergic dominance. ECT, which produces an instant sympathoadrenal activation, might be helpful to reverse the cholinergic predominance into the adrenergic one to be followed with tricyclic drugs which appear to be working in the same direction but suffering from a lag time before their peak therapeutic effect.