Does adjunctive electro-convulsive therapy improve the speed of treatment response in schizophrenia? A systematic review and week-by-week meta-analyses of controlled clinical trials.

BACKGROUND: Electroconvulsive therapy (ECT) is sometimes recommended in patients with schizophrenia to hasten clinical response. However, there is limited research comparing the speed of response between ECT in combination with antipsychotic medication versus antipsychotics alone. We conducted a systematic review and meta-analyses of week-by-week clinical response to examine whether ECT augmentation leads to faster improvement in psychotic symptoms in patients with schizophrenia. METHODS: We searched PubMed/Medline and Cochrane Library for controlled trials which compared the combination of ECT and antipsychotic drugs (ECT + AP) with antipsychotic drugs alone (AP) in patients with schizophrenia. We performed a pairwise random-effects meta-analysis for each time point. Hedge's g was used as the effect size estimate. A multivariate mixed-effects meta-analysis was performed to test whether the response speed was different between the groups. RESULTS: Of a total of 4899 search results, 12 studies were included. In five of them, the authors reported that the ECT + AP group responded faster. Pairwise meta-analysis for each week showed that ECT + AP group was significantly superior to the AP group at week 1 [g = 0.897 (95 % CI 0.236-1.557)], week 2 [g = 0.986 (95 % CI 0.273-1.700)], and week 4 [g = 1.587 (95 % CI 0.180-2.995)], but not after that. The multivariate mixed-effects meta-analysis also showed a significant Group*Week interaction [B = 0.17(95 % CI 0.10-0.24), p < 0.001]. CONCLUSIONS: ECT augmentation in schizophrenia, given its potential for faster response, may have some advantage in acutely ill patients, particularly those requiring hospitalization and needing rapid symptom resolution.