Is electroconvulsive therapy effective as augmentation in clozapine-resistant schizophrenia?
Clozapine is considered to be the most effective antipsychotic drug for patients with treatment resistant schizophrenia, but up to a third of the patients do not respond to this treatment. Various strategies have been tried to augment the effect of clozapine in non-responders, one of these strategies being electroconvulsive therapy. However, its efficacy and safety are not yet clear. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified six systematic reviews including 55 studies, among them six randomized controlled trials addressing clozapine-resistant schizophrenia. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded electroconvulsive therapy probably augments response to clozapine in patients with treatment resistant schizophrenia, but it is not possible to determine if it leads to cognitive adverse effects because the certainty of the evidence is very low.
Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile. Address: Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 5º piso, Santiago Centro, Chile. Email: daceituno@med.puc.cl.
Lucas
L
Kittsteiner Manubens
Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile Proyecto Epistemonikos, Santiago, Chile.
Diego
D
Lobos Urbina
Proyecto Epistemonikos, Santiago, Chile; Departamento de Psiquiatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
David
D
Aceituno
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*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003024:Clozapine