Electroconvulsive Therapy Added to Non-Clozapine Antipsychotic Medication for Treatment Resistant Schizophrenia: Meta-Analysis of Randomized Controlled Trials.
This meta-analysis of randomized controlled trials (RCTs) examined the efficacy and safety of the combination of electroconvulsive therapy (ECT) and antipsychotic medication (except for clozapine) versus the same antipsychotic monotherapy for treatment-resistant schizophrenia (TRS). Two independent investigators extracted data for a random effects meta-analysis and pre-specified subgroup and meta-regression analyses. Weighted and standard mean difference (WMD/SMD), risk ratio (RR) ±95% confidence intervals (CIs), number needed to treat (NNT), and number needed to harm (NNH) were calculated. Eleven studies (n = 818, duration = 10.2±5.5 weeks) were identified for meta-analysis. Adjunctive ECT was superior to antipsychotic monotherapy regarding (1) symptomatic improvement at last-observation endpoint with an SMD of -0.67 (p<0.00001; I2 = 62%), separating the two groups as early as weeks 1–2 with an SMD of -0.58 (p<0.00001; I2 = 0%); (2) study-defined response (RR = 1.48, p<0.0001) with an NNT of 6 (CI = 4–9) and remission rate (RR = 2.18, p = 0.0002) with an NNT of 8 (CI = 6–16); (3) PANSS positive and general symptom sub-scores at endpoint with a WMD between -3.48 to -1.32 (P = 0.01 to 0.009). Subgroup analyses were conducted comparing double blind/rater-masked vs. open RCTs, those with and without randomization details, and high quality (Jadad≥adadup analyses were Jadad<3) studies. The ECT-antipsychotic combination caused more headache (p = 0.02) with an NNH of 6 (CI = 4–11) and memory impairment (p = 0.001) with an NNH of 3 (CI = 2–5). The use of ECT to augment antipsychotic treatment (clozapine excepted) can be an effective treatment option for TRS, with increased frequency of self-reported memory impairment and headache.



CRD42014006689 (PROSPERO).
The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
Wei
W
Zheng
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.|Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China.
Xiao-Lan
XL
Cao
School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia.|The University of Notre Dame Australia / Marian Centre, Perth, Australia.
Gabor S
GS
Ungvari
The National Clinical Research Center for Mental Disorders & Beijing Anding Hospital, Capital Medical University, Beijing, China.
Ying-Qiang
YQ
Xiang
The National Clinical Research Center for Mental Disorders & Beijing Anding Hospital, Capital Medical University, Beijing, China.
Tong
T
Guo
Mental Hospital of Guangzhou Civil Administration, Guangzhou, 510430, China.
Zheng-Rong
ZR
Liu
Department of Epidemiology and Biostatistics, Faculty of Public Health, Wuhan University, Wuhan, Hubei province, China.
Yuan-Yuan
YY
Wang
McLean Hospital Belmont, MA & Harvard Medical School, Department of Psychiatry, Boston, MA, United States of America.
Brent P
BP
Forester
McLean Hospital Belmont, MA & Harvard Medical School, Department of Psychiatry, Boston, MA, United States of America.
Stephen J
SJ
Seiner
Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
Yu-Tao
YT
Xiang
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004351:Drug Resistance; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000628:therapy*; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003024:Clozapine