The combined use of electroconvulsive therapy and antipsychotics in patients with schizophrenia

OBJECTIVES: We sought to review the literature on the use of combined antipsychotic medications and electroconvulsive therapy (ECT) for the treatment of schizophrenia, with regard to efficacy, side effects, and ECT technique. METHODS: A computerized search of the literature published from 1980 to 2004 was conducted on Medline and PsychoInfo using the words schizophrenia, antipsychotic, neuroleptic, psychotropic, and ECT. Only studies including patients with the diagnosis of schizophrenia were included. RESULTS: We identified 42 articles including 1371 patients. The majority of the reports consist of uncontrolled studies (n = 31), mostly with typical antipsychotics (n = 23). Results from open studies suggest that the combination of ECT and antipsychotics is a very useful and safe strategy for the treatment of refractory schizophrenia. Double-blind controlled studies (n = 8) were inconclusive. Twelve articles were on the combination of clozapine and ECT. Initial concerns about the safety of the coadministration of clozapine and ECT were not substantiated, but despite the auspicious results from several case reports and 2 open trials, this combination remains understudied. Most studies preferred the bitemporal placement (n = 28), but because of insufficient data derived from direct comparisons, no conclusion on placement superiority can be reached. One study indicates that with the bilateral placement higher electrical dosages yields faster responses in this population. CONCLUSIONS: The body of the data provided by research is still insufficient to allow definitive conclusions on the combination of antipsychotics and ECT. However, the literature reviewed indicates that the combination is a safe and efficacious treatment strategy for patients with schizophrenia, especially those refractory to conventional treatments.