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Published on: August 15, 2017
Adjunctive Electroconvulsive Therapy for Schizophrenia: A Meta-analysis of Randomized Rater-Masked Controlled Trials
Wei Zheng1, Yu-Tao Xiang, Yi-Lang Tang
1From the *The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou; †The National Clinical Research Center for Mental Disorders, China and Center of Depression, Beijing Institute for Brain Disorders, Beijing Anding Hospital, Capital Medical University, Beijing; ‡Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China; §Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA; ∥Shenzhen Key Laboratory for Psychological Healthcare and Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital and Shenzhen Mental Health Center, Shenzhen; ¶Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR; #Mental Hospital of Guangzhou Civil Administration, Guangzhou, China; **The University of Notre Dame Australia/Marian Centre; ††School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia; ‡‡University of Kentucky, Mental Health Research Center at Eastern State Hospital, Lexington, KY; §§Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada; and ∥∥Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain.
Objective:
The aim of the study was to examine published randomized controlled trials (RCTs) for the efficacy and safety of adjunctive electroconvulsive therapy (ECT) when combined with antipsychotics (APs) versus AP therapy for schizophrenia and related disorders during the acute phase.
Methods:
Two evaluators independently selected studies, extracted data, and conducted quality assessment and data synthesis. Standardized and weighted mean differences (SMD/WMD), risk ratio (RR) ±95% confidence intervals (CIs), number needed to treat (NNT), and number needed to harm (NNH) were calculated.
Results:
Twenty-two RCTs (n = 1365, age = 36.9 years, male = 53%), including double-blind (8 RCTs) and rater-masked (14 RCTs) designs, were identified and analyzed. Adjunctive ECT was superior to AP therapy regarding (1) symptomatic improvement at last-observation endpoint (standardized mean difference, -0.67; P < 0.00001; I = 79%); (2) study-defined response (RR = 1.81, I = 0%, P < 0.00001, NNT = 4) and remission (RR = 2.05, I = 0%, P = 0.0004, NNT = 13); and (3) positive, negative, and general psychopathology subscores (weighted mean difference, -4.01 to -1.79; P = 0.005-0.0001). Results were similar in all preplanned subgroup analyses including Chinese (11 RCTs) versus non-Chinese (7 RCTs) origin, those with a Jadad score 3 or higher (12 RCTs) versus lower than 3 (6 RCTs), and those with clozapine (5 RCTs) versus those with non-clozapine treatments (13 RCTs). Compared with AP therapy, adjunctive ECT AP was significantly associated with more headache (RR = 2.72, P = 0.04, NNH = 5) and memory impairment (RR = 14.24, P = 0.01, NNH = 7).
Conclusions:
Adjunctive ECT seems to be an effective and safe option for schizophrenia and related disorders during acute phases but was associated with transient memory impairment and headaches.
