April 21, 2005 -- Electroconvulsive therapy (ECT) may help some medications.patients in combination with
"There is no suggestion that ECT should be a sole treatment or treatment of first choice in schizophrenia," write the researchers, who reviewed 26 clinical trials conducted since the 1960s.
"remain the preferential treatment. There is some evidence to suggest that ECT appears to benefit some who have shown a limited response to antipsychotic medication," continues the study, published in The Cochrane Library.
"Also, in those who improve with ECT but relapse in spite of continuing on the prescribed antipsychotics, the continuation of ECT, given at longer intervals, together with antipsychotic drugs could reduce the possibility of relapse in the medium term."
More than 2 million people in the U.S. have schizophrenia, says the National Institute of Mental Health (NIMH).
Schizophrenia is a severe brain disease that interferes with normal brain and mental function. Patients may experience hallucinations, delusions, paranoia, and a significant lack of motivation. It is often disabling and profoundly affects all areas of life.
Medical care can help, but many patients still experience some symptoms throughout their lives, says an NIMH publication on schizophrenia.
Contrary to many Hollywood portrayals, schizophrenia does not involve multiple personalities and is not the same condition as dissociative identity disorder (also called multiple personality disorder or split personality).
ECT, Past and Present
ECT debuted in 1938, say the researchers, who included Prathap Tharyan, head of psychiatry at India's Christian Medical College.
ECT use declined when psychiatric drugs were developed in the 1950s and in light of "public and professional concerns that ECT is invasive and causes brain damage," say the researchers.
Today, ECT is much less risky than those old-time treatments. The NIMH calls it a highly effective treatment for severe depression and notes that "the possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques."
The potential risks and benefits should be carefully reviewed and discussed by people considering ECT, says the NIMH.
Before ECT, patients are given anesthesia and a muscle relaxant. Then, an electrical current is briefly sent to the brain through electrodes place on the head. The electrical stimulation lasts up to eight seconds and produces a short seizure.
A course of ECT usually consists of six to 12 treatments given three times a week for a month or less, says the American Psychiatric Association (APA).
The international trials reviewed by Tharyan and colleagues had a combined total of 1,485 schizophrenia patients, all of whom were adults. A total of 798 participants got ECT.
Tharyan and colleagues weren't thrilled with the amount of research that was available. They looked through five decades of science and found few trials that were relevant.
From that limited pool, they say there is some evidence that ECT could be helpful for some schizophrenia patients in addition to antipsychotic medications.
"When participants were given ECT alone, mental state was less likely to improve over the medium term than if they were also given antipsychotic drugs," the researchers write.
"Even if the benefit of ECT is short-term, this may be of particular relevance in situations where speed of improvement is important," writes Tharyan.
The researchers say more research is needed and that it would be "unfortunate" if current guidelines precluded ECT as a treatment option, especially for patients "who have exhausted other options or who have limited options to begin with."
They say 20% of people with schizophrenia fail to respond to antipsychotics.
No trial participants were reported to have died during or immediately after ECT.
Data on deaths weren't a priority in the studies, but "the very few deaths that did occur in these trials do not implicate the course of ECT, and, overall, mortality seems to be low," the review notes.
However, some data pointed to a brief and "probably slight" memory impairment stemming from ECT.
A small trial (40 people) from China found greater memory impairment after a course of ECT combined with antipsychotic drugs than with the drugs alone. But after retesting nine weeks later, the researchers reported that memory had improved in both groups, making the difference no longer significant.
The APA says immediate side effects from ECT are rare except for headaches, muscle aches or soreness, nausea, and confusion. Some patients also report partial memory loss of events that occurred days, weeks, or months before ECT. Most of those memories typically return, but patients have reported longer-lasting problems with recall of those memories, says the APA.