Table 4.
Systematic review of studies administering clozapine augmented with ECT.
| Author (Year, Country) | Age (mean years) | Design | Number of patients | Setting | General anesthesia, electrode placement, seizure threshold | Duration of Illness (mean years) | Dosage of Drug (mg/day) | Mean number of treatments | Scales Used For Evaluation | Inference |
|---|---|---|---|---|---|---|---|---|---|---|
| Petrides et al. (2015, USA) | ECT+ Clozapine = 35.7 ± 2.27; Clozapine = 42.78 ± 1.82 | Randomized, Controlled, Single-blind, Crossover trial | Total = 39; ECT+ clozapine = 20; clozapine = 19 | Inpatient | General anesthesia, bilateral electrodes, seizure threshold: 5 to 60% | > 2 | ECT+ Clozapine = 525; clozapine = 511.1 | Randomized phase = 15.8 ± 4.2; Crossover phase = 14.3 ± 5.3 | Psychotic: BPRS | 50% response rate was recorded, 40% reduction of the symptoms, & 60% response rate for the congenial response criteria. |
| Gray & James et al. (1999, UK) | 30 | Open-Label Trial | Total = 6 | Inpatient | General anesthesia, bilateral electrodes, seizure threshold: NA | 14.33 | 525 | 12 | Psychotic: BPRS | Improvement in BPRS from Baseline = 71 to Endpoint = 48 |
| Kho et al. (2004, Netherlands) | 43 | Open-label trial | Total = 11 | Inpatient, one patient was outpatient | General anesthesia, Unilateral, later bilateral electrodes, seizure threshold: based on age | 16.16 | Nil | 8.1 | Psychotic: PANSS | The PANSS scores reduced from 74.54 to 49.181 |
| Masoudzadeh et al. (2007, Iran) | Clozapine = 31; ECT = 33; combined therapy = 30 | Randomized control trial (Unblinded study) | Total = 18; ECT = 6; clozapine = 6; Clozapine + ECT = 6 | Inpatient | Drug-induced sedation without causing seizure, Unilateral electrode | Nil | 200 | 12 | Psychotic: PANSS | 46% reduction in the PANSS score of sham ECT group, 40% reduction in sham clozapine group, and 71% reduction was seen in the ECT + Clozapine group. PANSS scores for the combination therapy group reduced from 99 to 29, with p-value 0.001. |
| Kim et al. (2017, Korea) | Female = 44.4 ± 14.2; Male = 34.0 ± 15.6 | Retrospective Case series study | Total = 7; Female = 5; Male = 2 | NA | General anesthesia, bilateral electrodes, seizure threshold: NA | Female = 16.0 ± 8.9; Male = 12.5 ± 10.6 | Before ECT = 350 ± 146.5 After ECT = 260.7 ± 95.6 During ECT >350 | 13.4 ± 4.6 | Psychotic: PANSS | Significant reduction in the mean PANSS scores from 70.1 ± 17.9 to 52.3 ± 17.9; One patient did not respond to ECT. |
| Benatov et al. (1996, Israel) | 42.33 (calculated) | Case series | Total = 3 | Inpatient | General anesthesia NA, Bilateral electrode placement, Seizure threshold: NA |
23.33 (calculated) | 416.66 (calculated) | 14.33(calculated) | Psychotic: BPRS & PANSS | All the patients showed an overall improvement in BPRS, PANSS as follows: Patient 1: BPRS − 68 to 39 PANSS − 122 to 78 Patient 2: BPRS- reduced by 40% from 75 PANSS- 125 to 72 Patient 3: Positive effect on symptoms |
| Frankenburg et al. (1993, USA) | 37.66 ± 8.731 (calculated) | Open trial | Total = 12 Responders = 10; Non-responders = 2 | Inpatient | General anesthesia, unilateral electrode, stimulus to cause seizure for 30 −60 secs. | 14.916 ± 5.017 (calculated) | 322.91(calculated) | 10.08 ± 4.813 (calculated) | No scale was reported. | Improvement was reported in terms of the extent of clinical response. 3 patients showed high response, 1 showed moderate response, 4 a minimal response, 2 minimal to no response, and 2 no response. |
| Cardwell et al. (1995, USA) | 41.25 | Retrospective chart review | Total = 7; Male = 3; Female = 4 | NA | NA | 1 year | 580 | 21.6 | Psychotic: BPRS | BPRS scores improved by 26.9% |
| Grover et al. (2015, India) | 32.7 ± 6.4 | Total = 11 | Outpatient | Anesthesia: NA, Bilateral electrodes, seizure threshold: NA | 123.4 ± 60.5 months | 339.8 ± 120.8 | 12.81 ± 6.6 | Psychotic: PANSS | PANSS scores reduced from baseline 77.1 ± 15.1 to Endpoint = 52.8 ± 9.6 |