ECT for Schizophrenia: Effectiveness, Treatments, Side Effects

Electroconvulsive therapy (ECT) is a treatment for severe mental health conditions, including schizophrenia.

Though it’s more commonly used to treat major depressive disorder and bipolar disorder, ECT can also benefit many people with schizophrenia. Healthcare professionals may recommend ECT when other treatments, like therapy and medication, haven’t helped.

ECT isn’t a cure for schizophrenia and it’s typically used in combination with other treatments. That said, it may help change certain parts of brain function involved in schizophrenia symptoms. Some people describe the process as rebooting your brain like a computer. Of course, it isn’t quite that simple.

This article explores the effectiveness of ECT for schizophrenia. You’ll learn about what to expect during and after the procedure, as well as who makes a good candidate for ECT.

Research suggests that ECT is an effective treatment for people with schizophrenia who don’t respond to other treatments.

In particular, the authors of a 2019 review of studies concluded that ECT, as an add-on therapy, was an effective treatment for people with treatment-resistant schizophrenia. They added that people typically experience minimal cognitive side effects from ECT. In some cases, they may even see cognitive improvements.

The authors of a 2018 review came to a similar conclusion. They added that ECT may be a useful therapy for other people with schizophrenia, not only those who have not found help in other treatments.

The authors of a different 2019 review agreed that, when used as an add-on therapy for people with treatment-resistant schizophrenia, ECT can have a positive effect. But they said there is a need for more research into using ECT for schizophrenia before it can be recommended as a standard part of care.

Finally, a 2021 study of hospital records from 2,131 people with schizophrenia found that people who received ECT treatment were less likely to be readmitted to the hospital within the next 6 months.

But some people with schizophrenia don’t see their symptoms improve after ECT. It’s not entirely clear why. In addition, some people have more difficulty than others tolerating the potential side effects of the procedure.

Combining ECT and medication

According to the American Psychiatric Association (APA) guidelines for schizophrenia treatment, released in 2021, some research suggests that using medication alongside ECT might make ECT more effective.

Several studies have focused on the use of ECT and clozapine, an atypical antipsychotic that’s frequently used to treat schizophrenia.

A 2016 review of clinical trials and other medical reports looked at the combined effects of ECT and clozapine in 192 people with treatment-resistant schizophrenia. The authors reported that about 66% of people responded positively to the treatment. They noted that ECT may also increase the effectiveness of clozapine.

ECT is a painless procedure that’s done while you’re under anesthesia. Doctors attaches electrodes to your head, which discharges a series of mild electrical currents. This triggers a controlled seizure.

ECT is done in a hospital or medical clinic. It’s typically an outpatient procedure, which means you can be in and out relatively quickly.

Your doctor will provide you with instructions on what to do before your procedure. You may be asked to avoid food and drink for about 8 hours before your procedure so that you can have general anesthesia.

Your healthcare team might begin by checking your vital signs and inserting an IV. A doctor will then position several electrodes on your head. Some of these electrodes monitor your brain activity, while others deliver the electrical currents that trigger the seizure.

Your medical team will give you medications through your IV line, including anesthesia to put you to sleep and a muscle relaxant to prevent your muscles from contracting during the seizure.

The procedure itself lasts only a few minutes. Once you wake up, you’ll rest while nurses watch to make sure your vital signs have returned to usual.

Doctors usually recommend having someone take you home and staying with you after the treatment. You shouldn’t drive for the next 24 hours.

Your doctor will determine the best treatment schedule for you, but ECT is typically done 2 to 3 times per week for around 4 to 6 weeks.

People with schizophrenia might require up to 20 sessions in total. A higher number of sessions appears to be associated with greater improvements in symptoms.

For example, the authors of the 2021 study of hospital admissions found that among the people with schizophrenia who received ECT treatments, those who received nine or more sessions were less likely to be readmitted in the following 6 months than those who received fewer than nine sessions .

According to a 2018 review, there is some evidence to support the use of ECT at regular intervals throughout life to prevent relapse in people with schizophrenia. This is known as maintenance ECT (M-ECT).

A small 2020 cohort study found that M-ECT was generally well-tolerated and effective in maintaining symptom improvements. But, significant cognitive effects were reported in 11% of cases.

There are a number of common misconceptions about electroconvulsive therapy. In the past, people received high doses of electricity without anesthesia, which caused significant pain and memory loss.

Today, ECT involves small, controlled doses of electricity targeted at specific areas of the brain. It is given only to people under anesthesia, so there’s no pain involved.

Although ECT still has a risk of side effects, they tend to be mild and temporary. Potential side effects include:

  • Confusion: You might feel confused or disoriented when you wake up from the procedure. The confusion associated with ECT usually goes away within a few hours, but it can last longer for some people.
  • Memory impairments: ECT may cause minor memory loss. You might not be able to remember what happened immediately before or after the procedure. You might also have difficulty remembering events that happened during the weeks you received treatment. Memory impairments are temporary and usually resolve once treatment ends.
  • Stiffness: Following the procedure, you might experience muscle aches, tension, or stiffness. For instance, your jaw or head might hurt.
  • Nausea: Nausea is a potential side effect of both general anesthesia and ECT. If necessary, your doctor can provide medication to help with nausea.
  • Medical complications: Most people can undergo general anesthesia without experiencing complications. But health concerns such as heart conditions or high blood pressure may increase your risk of complications.

If you’re concerned about side effects, talk with a doctor. They can help you balance the potential risks and benefits of ECT based on your medical history and symptoms.

Antipsychotic drugs are the first-line treatment for schizophrenia. Typical antipsychotics include chlorpromazine, fluphenazine, and haloperidol. Atypical antipsychotics, which some people think have a better side effect profile, include clozapine and risperidone.

Yet, up to 30% of people with schizophrenia do not experience a satisfactory improvement in their symptoms after taking antipsychotic drugs. In these cases, ECT may be used alongside the medication.

In other words, your doctor probably won’t suggest ECT unless you’ve tried a few medications and they have not helped. In addition, your doctor might recommend other interventions, such as cognitive behavioral therapy (CBT), before ECT.

The APA suggests that combining antipsychotic medication and ECT might help people who have severe symptoms of schizophrenia, such as catatonia or suicidal behavior. If ECT helps, it can be used on a regular maintenance basis.

Brain stimulation therapies use electricity or magnets to adjust brain chemistry and function. Although ECT is the most commonly used brain stimulation therapy for schizophrenia, others are available.

Transcranial magnetic stimulation (TMS)

TMS stimulates the nervous system via electromagnetic pulses. It’s been used to treat several mental health conditions, including depression and anxiety.

According to the APA, there isn’t enough evidence that TMS can help with symptoms of schizophrenia. There is a need for more high quality research on the role of TMS in treating schizophrenia.

Deep brain stimulation (DBS)

DBS is used to treat health conditions that affect movement, such as epilepsy and Parkinson’s disease. Electrodes are implanted in the brain, where they give electrical pulses that regulate brain activity. These pulses can be controlled by a small device on the chest that works similarly to a pacemaker.

DBS is a relatively new therapy, and there isn’t much research into whether it can help people with schizophrenia. According to the APA, it might be useful in treating tardive dystonia, a side effect associated with the long-term use of antipsychotic medications.

Vagus nerve stimulation (VNS)

VNS involves using a small device to send a mild electrical pulse up the vagus nerve to the brainstem. The vagus nerve plays a role in several key biological functions, including digestion and mood.

While this therapy can effectively treat migraine attacks, seizures, and depression, its role in treating schizophrenia is unclear. There is currently not enough evidence to conclude that VNS can benefit people with schizophrenia.

ECT is a treatment for schizophrenia that’s used when other medications and therapies have not worked. It involves sending a mild electrical current through the brain to alternate nervous system activity.

While ECT is a short procedure, treatment involves several weekly sessions for around 4 to 6 weeks. In most cases, it’s used alongside antipsychotic medication.

Side effects of ECT can include temporary memory loss and physical symptoms such as nausea, stiffness, and headaches. Talk with a doctor if you’re interested in exploring the benefits of ECT for yourself or a loved one.

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