CLOZAPINE FOLLOWING ECT - A 2-STEP TREATMENT

Background: Some candidates for clozapine treatment may be unable to b e given the drug. They may be so severely ill that they cannot or will not ingest a pill; their psychosis may have so compromised their phys ical status that use of clozapine, which produces a broad range of sid e effects, would be unsafe; and/or they may require a very rapid contr ol of their behavior. Method: Two case reports are described of patien ts who, although candidates for clozapine, were unable to take or be g iven the drug. Initial treatment with electroconvulsive therapy (ECT) was tried in both patients prior to use of clozapine. Results: In the two cases described, treatment with ECT prior to clozapine stabilized the patients enough that clozapine could be administered. In both case s, the clozapine appeared to perpetuate the initial clinical response produced by the ECT. Conclusion: These case reports suggest that a two -step strategy of ECT followed by clozapine treatment may both facilit ate the use of clozapine in some patients and perpetuate the clinical stability produced by ECT alone.