title: Clozapine following ECT: a two-step treatment.
abstract: BACKGROUND
  Some candidates for clozapine treatment may be unable to be given the drug. They may be so severely ill that they cannot or will not ingest a pill; their psychosis may have so compromised their physical status that use of clozapine, which produces a broad range of side effects, would be unsafe; and/or they may require a very rapid control of their behavior.
  
  
  METHODS
  Two case reports are described of patients who, although candidates for clozapine, were unable to take or be given the drug. Initial treatment with electroconvulsive therapy (ECT) was tried in both patients prior to use of clozapine.
  
  
  RESULTS
  In the two cases described, treatment with ECT prior to clozapine stabilized the patients enough that clozapine could be administered. In both cases, the clozapine appeared to perpetuate the initial clinical response produced by the ECT.
  
  
  CONCLUSIONS
  These case reports suggest that a two-step strategy of ECT followed by clozapine treatment may both facilitate the use of clozapine in some patients and perpetuate the clinical stability produced by ECT alone.
authors.affiliation: Commonwealth Research Center, Harvard Medical School, Boston, MA.
authors.forename: A I
authors.initials: AI
authors.lastname: Green
authors.forename: A
authors.initials: A
authors.lastname: Zalma
authors.forename: I
authors.initials: I
authors.lastname: Berman
authors.forename: C J
authors.initials: CJ
authors.lastname: DuRand
authors.forename: C
authors.initials: C
authors.lastname: Salzman
mesh_terms: D000328:Adult; D003024:Clozapine / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D003024:Clozapine