Augmentation of clozapine with ECT: a retrospective case analysis

Objective: We sought to assess the effectiveness of clozapine augmentation with Electroconvulsive therapy (ECT) (CþECT) in patients with clozapine-resistant schizophrenia. Methods: We conducted a retrospective review of electronic health records to identify patients treated with CþECT. We determined the response to CþECT and the rate of rehospitalisation over the year following treatment with CþECT. Results: Forty-two patients were treated with CþECT over a 10-year period. The mean age of the patients at initiation of ECT was 46.3 (SD = 8.2) years (range 27-62 years). The mean number of ECTs given was 10.6 (SD = 5.3) (range 3-25) with the majority receiving twice weekly ECT. Seventy-six per cent of patients (n = 32) showed a Clinical Global Impression-Improvement (CGI-I) score of ≤3 (at least minimally improved) following CþECT. The mean number of ECT treatments was 10.6 (SD = 5.3) (range 3-25) with the majority receiving twice weekly ECT. Sixty-four per cent of patients experienced no adverse events. Response to CþECT was not associated with gender, age, duration of illness or duration of clozapine treatment. Seventy-five per cent of responders remained out of hospital over the course of 1-year follow-up, while 70% of those with no response to CþECT were not admitted to hospital. Three patients received maintenance ECT, one of whom was rehospitalised. Conclusion: This study lends support to emerging evidence for the effectiveness of CþECT in clozapine-resistant schizophrenia. These results are consistent with the results of a meta-analysis and the only randomised controlled trial (RCT) of this intervention. Further RCTs are required before this treatment can be confidently recommended.