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 treatm ent by refusing to give blood for haematological monitoring or refusing to swallow tablets. Whereas electroconvulsive therapy (ECT) may be used for ra pid behavioural control, the effects wane once the treatment course comes t o an end. This paper reports an alternative strategy in such patients - com bined jointly initiated therapy with clozapine and ECT. Six disturbed patie nts with treatment resistant schizophrenia were given a course of 12 ECT ov er 6 weeks. Blood was drawn for clozapine monitoring during the first anaes thetic, allowing the introduction of clozapine on day 6. There was a mean 3 2% improvement in Brief Psychiatric Rating Scale scores at week 6. This imp rovement persisted after the cessation of ECT, by which time all patients w ere compliant with blood testing and tablet taking. There were no adverse r eactions apparent in the combination of the two therapies. Elective combine d ECT and clozapine therapy may be useful in treatment-resistant schizophre nics where the clinical state necessitates a rapid therapeutic response and where blood tests are refused. A possible synergistic reaction between clo zapine and ECT is Worthy of further investigation. mt Clin Psychopharmacol 14:69-72 (C) 1999 Lippincott Williams & Wilkins.