Elective combined electroconvulsive and clozapine therapy

Clozapine therapy does not produce the rapid response that may be required in severely disturbed patients. The latter, not uncommonly, obstruct treatment by refusing to give blood for haematological monitoring or refusing to swallow tablets. Whereas electroconvulsive therapy (ECT) may be used for rapid behavioural control, the effects wane once the treatment course comes to an end. This paper reports an alternative strategy in such patients--combined jointly initiated therapy with clozapine and ECT. Six disturbed patients with treatment resistant schizophrenia were given a course of 12 ECT over 6 weeks. Blood was drawn for clozapine monitoring during the first anaesthetic, allowing the introduction of clozapine on day 6. There was a mean 32% improvement in Brief Psychiatric Rating Scale scores at week 6. This improvement persisted after the cessation of ECT, by which time all patients were compliant with blood testing and tablet taking. There were no adverse reactions apparent in the combination of the two therapies. Elective combined ECT and clozapine therapy may be useful in treatment-resistant schizophrenics where the clinical state necessitates a rapid therapeutic response and where blood tests are refused. A possible synergistic reaction between clozapine and ECT is worthy of further investigation.