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When standard treatment with the newer antipsychotic medications fails to relieve symptoms of schizophrenia, psychiatrists may turn to clozapine. However, half of the patients taking clozapine may remain resistant to the medication, leaving both physicians and patients with few alternatives. “The treatment of this subgroup of patients remains an enormous challenge, with significant public-health implications,” said Georgios Petrides, M.D., an associate professor of psychiatry and behavioral sciences at the Zucker Hillside Hospital, Northshore-Long Island Jewish Health System, in the report, "Electroconvulsive Therapy Augmentation in Clozapine-Resistant Schizophrenia: A Prospective, Randomized Study," in AJP in Advance.
So Petrides and colleagues augmented clozapine with ECT in a randomized, single-blind study of 39 patients. Response was defined as a 40% reduction in symptoms, twice the standard usually used in medication trials. Fifty percent of the patients receiving ECT achieved that response, as did 47% of patients in the control arm during the crossover phase of the trial. “These are among the highest response rates ever recorded in this patient population,” wrote Petrides and colleagues. “The augmentation of clozapine with ECT for the treatment of clozapine-resistant schizophrenia is a safe and effective treatment option.”
The high response rate and blinded rating process used is encouraging and makes it worth looking at this approach in a larger, longer-lasting study, said ECT specialist William McDonald, M.D., a professor of psychiatry and behavioral sciences at Emory University School of Medicine, in an interview with Psychiatric News. “This is a nice, clinically oriented trial that will really add to the field.”
To read more about the use clozapine in schizophrenia, see the Psychiatric News article, "Multiple Factors Affect Use of Clozapine for Schizophrenia."
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