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Combined use of clozapine and ECT: a review

Published online by Cambridge University Press: 20 February 2015

Sandeep Grover,
Nandita Hazariand
Natasha Kate
Sandeep Grover*
Affiliation:
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Nandita Hazari
Affiliation:
Department of Psychiatry, KEM Hospital, Mumbai, India
Natasha Kate
Affiliation:
Department of Psychiatry, KEM Hospital, Mumbai, India
*
Dr. Sandeep Grover, Assistant Professor, Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India. Tel: +0091 172 2756807 (O); Fax: +91 172 2744401; 2745078; E-mail:drsandeepg2002@yahoo
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Abstract

Objective

This paper aims to review the available evidence for the use of clozapine and electroconvulsive therapy (ECT) in combination.

Methodology

Electronic searches were carried out to identify reports describing the combined use of clozapine and ECT.

Results

Forty reports including 208 patients were identified. The majority of reports were in the form of case reports and case series, with few retrospective and open-label studies. The majority of patients were aged between 18 and 65 years and diagnosed with schizophrenia or schizoaffective disorder. Most of the patients refractory to clozapine were started on ECT as an augmentation therapy; however, in some reports, both ECT and clozapine were started concurrently, and in few cases clozapine was started after ECT. In terms of effectiveness, 37.5–100% patients improved in short-term, and sustained long-term improvement (3 weeks to 24 months) was described in few studies. In terms of the side-effect profile, five patients each had delirium and tachycardia and only four patients were described to have prolonged seizures. Overall, the combination was considered effective and safe.

Conclusion

There is evidence for the effectiveness and safety of the clozapine–ECT combination and it should be used in patients with treatment-resistant schizophrenia who do not respond to clozapine.

Keywords

augmentationclozapineECT
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 27 , Issue 3 ,June 2015,pp. 131 - 142
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Copyright
© Scandinavian College of Neuropsychopharmacology 2015

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References

1.Kane,JM,Honigfeld,G,Singer,J,Meltzer,H.Clozapine in treatment-resistant schizophrenics.Psychopharmacol Bull1988;24:62–67.Google ScholarPubMed
2.Meltzer,HY.Defining treatment refractoriness in schizophrenia.Schizophr Bull1990;16:563–565.CrossRefGoogle ScholarPubMed
3.Sinclair,D,Adams,CE.Treatment resistant schizophrenia: a comprehensive survey of randomised controlled trials.BMC Psychiatry2014;14:253–260.CrossRefGoogle ScholarPubMed
4.Aleman,A,Sommer,IE,Kahn,RS.Efficacy of slow repetitive transcranial magnetic stimulation in the treatment of resistant auditory hallucinations in schizophrenia: a meta-analysis.J Clin Psychiatry2007;68:416–421.CrossRefGoogle ScholarPubMed
5.Thirthalli,J,Bharadwaj,B,Kulkarni,S,Gangadhar,BN,Kharawala,S,Andrade,C.Successful use of maintenance rTMS for 8 months in a patient with antipsychotic-refractory auditory hallucinations.Schizophr Res2008;100:351–352.CrossRefGoogle Scholar
6.Wang,J,Xu,Y.Should repetitive transcranial magnetic stimulation (rtms) be considered an effective adjunctive treatment for auditory hallucinations in patients with schizophrenia?Shanghai Arch Psychiatry2013;25:254–255.Google ScholarPubMed
7.Aleman,A.Use of repetitive transcranial magnetic stimulation for treatment in psychiatry.Clin Psychopharmacol Neurosci2013;11:53–59.CrossRefGoogle ScholarPubMed
8.Shi,C,Yu,X,Cheung,EF,Shum,DH,Chan,RC.Revisiting the therapeutic effect of rTMS on negative symptoms in schizophrenia: a meta-analysis.Psychiatry Res2014;215:505–513.CrossRefGoogle ScholarPubMed
9.Andrade,C.Once- to twice-daily, 3-year domiciliary maintenance transcranial direct current stimulation for severe, disabling, clozapine-refractory continuous auditory hallucinations in schizophrenia.J ECT2013;29:239–242.CrossRefGoogle ScholarPubMed
10.Braga,RJ,Petrides,G.The combined use of electroconvulsive therapy and antipsychotics in patients with schizophrenia.J ECT2005;21:75–83.CrossRefGoogle ScholarPubMed
11.Chanpattana,W,Kunigiri,G,Kramer,BA,Gangadhar,BN.Survey of the practice of electroconvulsive therapy in teaching hospitals in India.J ECT2005;21:100–104.CrossRefGoogle ScholarPubMed
12.Chanpattana,W,Andrade,C.ECT for treatment-resistant schizophrenia: a response from the far East to the UK. NICE report.J ECT2006;22:4–12.CrossRefGoogle Scholar
13.Chanpattana,W,Kramer,BA,Kunigiri,G,Gangadhar,BN,Kitphati,R,Andrade,C.A survey of the practice of electroconvulsive therapy in Asia.J ECT2010;26:5–10.CrossRefGoogle ScholarPubMed
14.Fink,M.ECT and clozapine in schizophrenia.J ECT1998;14:223–226.CrossRefGoogle ScholarPubMed
15.Klapheke,MM.Clozapine, ECT, and Schizoaffective disorder, bipolar type.Convuls Ther1991;7:36–39.Google ScholarPubMed
16.Klapheke,MM.Follow-up on clozapine and ECT.Convuls Ther1991;7:303–305.Google ScholarPubMed
17.Masiar,SJ,Johns,CA.ECT following clozapine.Br J Psychiatry1991;158:135–136.CrossRefGoogle ScholarPubMed
18.Bloch,Y,Pollack,M,Mor,I.Should the administration of ECT during clozapine therapy be contraindicated?Br J Psychiatry1996;169:253–254.CrossRefGoogle ScholarPubMed
19.Kupchik,M,Spivak,B,Mester,Ret al.Combined electroconvulsive-clozapine therapy.Clin Neuropharmacol2000;23:14–16.CrossRefGoogle ScholarPubMed
20.Havaki-Kontaxaki,BJ,Ferentinos,PP,Kontaxakis,VP,Paplos,KG,Soldatos,CR.Concurrent administration of clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia.Clin Neuropharmacol2006;29:52–56.CrossRefGoogle ScholarPubMed
21.Tranulis,C,Mouaffak,F,Chouchana,Let al.Somatic augmentation strategies in clozapine resistance – what facts?Clin Neuropharmacol2006;29:34–44.CrossRefGoogle ScholarPubMed
22.Vayisoğlu,S,Yağcioğlu,AE.Augmentation strategies in patients with schizophrenia who show partial response to clozapine treatment.Turk Psikiyatri Derg2014;25(3):201–211.Google ScholarPubMed
23.Manjunatha,N,Ram Kumar,GS,Vidyendaran,R,Muralidharan,K,John,JP.Delayed onset, protracted delirium and aspiration pneumonitis associated with a combination of clozapine and electroconvulsive therapy.Indian J Psychol Med2011;33:80–82.CrossRefGoogle ScholarPubMed
24.Grubisha,M,Gopalan,P,Azzam,PN.Takotsubo cardiomyopathy in a young man after maintenance electroconvulsive therapy and clozapine initiation: a case report.J ECT2014;30:e40–41.CrossRefGoogle Scholar
25.Frankenberg,FR,Suppes,T,Mclean,PE.Combined clozapine and electroconvulsive therapy.Convulsive Ther1993;9:176–180.Google Scholar
26.Kho,KH,Blansjaar,BA,De Vries,S,Babuskova,D,Zwinderman,AH,Linszen,DH.Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia: an open label study.Eur Arch Psychiatry Clin Neurosci2004;254:372–379.CrossRefGoogle ScholarPubMed
27.Flamarique,I,Castro-Fornieles,J,Garrido,JMet al.Electroconvulsive therapy and clozapine in adolescents with schizophrenia spectrum disorders: is it a safe and effective combination?J Clin Psychopharmacol2012;32:756–766.CrossRefGoogle ScholarPubMed
28.Kristensen,D,Hageman,I,Bauer,J,Jørgensen,MB,Correll,CU.Antipsychotic polypharmacy in a treatment-refractory schizophrenia population receiving adjunctive treatment with electroconvulsive therapy.J ECT2013;29:271–276.CrossRefGoogle Scholar
29.Petrides,G,Malur,C,Braga,RJ,Bailine,SH,Schooler,NR,Malhotra,AK.Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study.Am J Psychiatry2015;172:52–58.CrossRefGoogle ScholarPubMed
30.Factor,SA,Molho,ES,Brown,DL.Combined clozapine and electroconvulsive therapy for the treatment of drug-induced psychosis in Parkinson’s disease.J Neuropsychiatry Clin Neurosci1995;7:304–307.Google ScholarPubMed
31.Kales,HC,Dequardo,JR,Tandon,R.Combined electroconvulsive therapy and clozapine in treatment-resistant schizophrenia.Prog Neuropsychopharmacol Biol Psychiatry1999;23:547–556.CrossRefGoogle ScholarPubMed
32.Beale,MD,Pritchett,JT,Kellner,CH.Supraventricular tachycardia in a patient receiving ECT, clozapine, and caffeine.Convuls Ther1994;10:228–231.Google Scholar
33.Cardwell,BA,Nakai,B.Seizure activity in combined clozapine and ECT: a retrospective view.Convuls Ther1995;11:110–113.Google ScholarPubMed
34.Masoudzadeh,A,Khalilian,AR.Comparative study of clozapine, electroshock and the combination of ECT with clozapine in treatment-resistant schizophrenic patients.Pak J Biol Sci2007;10:4287–4290.CrossRefGoogle ScholarPubMed
35.Koen,L,Van Den Berg,CE,Niehaus,DJH.Combining ECT and clozapine in the treatment of clozapine-refractory schizophrenia and schizoaffective disorder – a pilot study.S AfrJ Psychiatry2008;14:131–135.Google Scholar
36.Kales,HC,Tandon,R,Dequardo,JR,Maixner,D,Jibson,M,Becks,L.Combined electroconvulsive therapy and clozapine in schizophrenia.J Clin Psychiatry1995;37:678.Google Scholar
37.Fink,M.Clozapine and electroconvulsive therapy.Arch Gen Psychiatry1990;47:290–291.CrossRefGoogle ScholarPubMed
38.Petrides,G,Fink,M,Abaza,A,Francis,A.Concurrent use of ECT and atypical antipsychotic medication.Convulsive Ther1998;14:139–140.Google Scholar
39.Bannour,S,Bouhlel,S,Krir,MWet al.Combination of maintenance electroconvulsive therapy and clozapine in treating a patient with refractory schizophrenia.J ECT2014;30:e29–e30.CrossRefGoogle ScholarPubMed
40.Biedermann,F,Pfaffenberger,N,Baumgartner,S,Kemmler,G,Fleischhacker,WW,Hofer,A.Combined clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia: clinical and cognitive outcomes.J ECT2011;27:e61–e62.CrossRefGoogle ScholarPubMed
41.James,DV,Gray,NS.Elective combined electroconvulsive and clozapine therapy.Int Clin Psychopharmacol1999;14:69–72.CrossRefGoogle ScholarPubMed
42.Vowels,EC,Hitturlingappa,S,Bastiampillai,T.Combination clozapine and electroconvulsive therapy in a patient with schizophrenia and comorbid intellectual disability.Aust N Z J Psychiatry2014;48:689–690.CrossRefGoogle Scholar
43.Benatov,R,Sirota,P,Megged,S.Neuroleptic-resistant schizophrenia treated with clozapine and ECT.Convuls Ther1996;12:117–121.Google ScholarPubMed
44.Husni,M,Haggarty,J,Peat,C.Clozapine does not increase ECT-seizure duration.Can J Psychiatry1999;44:190–191.Google Scholar
45.Keller,S,Drexler,H,Lichtenberg,P.Very high dose clozapine and electroconvulsive therapy combination treatment in a patient with schizophrenia.J ECT2009;25:280–281.CrossRefGoogle Scholar
46.Dean,CE.Severe self-injurious behavior associated with treatment-resistant schizophrenia: treatment with maintenance electroconvulsive therapy.J ECT2000;16:302–308.CrossRefGoogle ScholarPubMed
47.Klapheke,MM.Combining ECT and antipsychotic agents: benefits and risks.Convuls Ther1993;9(4):241–255.Google ScholarPubMed
48.Landy,DA.Combined use of clozapine and electroconvulsive therapy: case report.Convulsive Ther1991;7:218–221.Google Scholar
49.Lurie,SN.Combined use of ECT and clozapine.J Clin Psychiatry1996;57:94–95.Google ScholarPubMed
50.Poyurovsky,M,Weizman,A.Safety and effectiveness of combined ECT and clozapine in treatment-resistant mania.Eur Psychiatry1996;11:319–321.CrossRefGoogle ScholarPubMed
51.Godemann,F,Hellweg,R.Twenty-year-long prophylactic treatment of a bipolar-affective psychosis unsuccessful.Nervenarzt1997;68:582–585.CrossRefGoogle Scholar
52.Chanpattana,W.Combined ECT and clozapine in treatment-resistant mania.J ECT2000;16:204–207.CrossRefGoogle ScholarPubMed
53.Tsao,CI,Jain,S,Gibson,RH,Guedet,PJ,Lehrmann,JA.Maintenance ECT for recurrent medication-refractory mania.J ECT2004;20:118–119.CrossRefGoogle ScholarPubMed
54.Safferman,AZ,Munne,R.Combining clozapine with ECT.Convuls Ther1992;8:141–143.Google ScholarPubMed
55.Bhatia,SC,Bhatia,SK,Gupta,S.Concurrent administration of clozapine and ECT: a successful therapeutic strategy for a patient with treatment-resistant schizophrenia.J ECT1998;14:280–283.CrossRefGoogle ScholarPubMed
56.Sienaert,P,Bouckaert,F,Fernandez,I,Hagon,A,Hagon,B,Peuskens,J.Propofol in the management of postictal delirium with clozapine-electroconvulsive therapy combination.J ECT2004;20:254–257.CrossRefGoogle ScholarPubMed
57.Kurian,S,Tharyan,P,Jacob,KS.Combination of ECT and clozapine in drug-resistant schizophrenia.Indian J Psychiatry2005;47:245.Google ScholarPubMed
58.Zervas,IM,Theleritis,C,Soldatos,CR.Using ECT in schizophrenia: a review from a clinical perspective.World J Biol Psychiatry2012;13:96–105.CrossRefGoogle ScholarPubMed
59.Trezise,K.ECT with clozapine: efficacy and safety.Br J Psychiatry1996;169:671.CrossRefGoogle ScholarPubMed
60.Taylor,DM,Young,C,Paton,C.Prior antipsychotic prescribing in patients currently receiving clozapine: a case note review.J Clin Psychiatry2003;64:30–34.CrossRefGoogle ScholarPubMed
61.Howes,OD,Vergunst,F,Gee,S,Mcguire,P,Kapur,S,Taylor,D.Adherence to treatment guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiation.Br J Psychiatry2012;201:481–485.CrossRefGoogle ScholarPubMed
62.Nielsen,J,Dahm,M,Lublin,H,Taylor,D.Psychiatrists’ attitude towards and knowledge of clozapine treatment.J Psychopharmacol2010;24:965–971.CrossRefGoogle ScholarPubMed
63.Moore,TA,Buchanan,RW,Buckley,PFet al.The Texas Medication Algorithm Project: antipsychotic algorithm for schizophrenia: 2006 update.J Clin Psychiatry2007;14:1751–1762.CrossRefGoogle Scholar
64.Taylor,D,Paton,C,Kapur,S.The Maudsley Prescribing Guidelines,10th edn.Informa Healthcare,2010,London, United Kingdom.Google Scholar
65.Warnez,S,Alessi-Severini,S.Clozapine: a review of clinical practice guidelines and prescribing trends.BMC Psychiatry2014;14:102–106.CrossRefGoogle ScholarPubMed