The quality of evidence is downgraded by study limitations (high risk of bias in blinding participants and personnel, imprecision).
A Cochrane review [Abstract] 1 included 15 studies with a total of 1285 subjects.
The included trials reported data for four comparisons: ECT plus antipsychotics compared with antipsychotics; ECT plus antipsychotics compared with sham-ECT added to antipsychotics; ECT plus antipsychotics compared with clozapine added to other antipsychotics; and ECT alone compared with antipsychotic alone.
When ECT plus antipsychotics was compared with antipsychotics, more participants in the ECT group had a clinically important response (medium term; RR 2.06, 95% CI 1.75 to 2.42; 9 studies; n=819; moderate-quality evidence). Results showed that adding ECT to antipsychotics may increase the risk of memory deterioration (short term; RR 27.00, 95% CI 1.67 to 437.68; 1 study; n=72; very low-quality evidence). Only average endpoint scale scores were available for mental state (BPRS) and general functioning (Global Assessment of Functioning). There were clear differences in scores, favouring ECT group for mental state (medium term; MD -11.18, 95% CI -12.61 to -9.76; 2 studies; n=345; low-quality evidence) and general functioning (medium term; MD 10.66, 95% CI 6.98 to 14.34; 2 studies; n=97; very low-quality evidence).
For the comparison ECT plus antipsychotics versus sham-ECT plus antipsychotics, only average endpoint BPRS (Brief Psychiatric Rating Scale) scores from one study were available for mental state; no clear difference between groups was observed (short term; MD 3.60, 95% CI -3.69 to 10.89; 1 study; n=25; very low-quality evidence).
When ECT plus antipsychotics was compared with clozapine added to other antipsychotics, data from one study showed no clear difference for clinically important response to treatment (medium term; RR 1.23, 95% CI 0.95 to 1.58; 1 study; n=162; low-quality evidence). Clinically important change in mental state data were not available, but average endpoint BPRS scores were reported. A positive effect for the ECT group was found (short-term BPRS; MD -5.20, 95% CI -7.93 to -2.47; 1 study; n=162; very low-quality evidence).
For the comparison ECT alone versus antipsychotics (flupenthixol) alone, only average endpoint scale scores were available for mental state and general functioning. Mental state scores were similar between groups (medium-term BPRS; MD -0.93, 95% CI -6.95 to 5.09; 1 study; n=30; very low-quality evidence); general functioning scores were also similar between groups (medium-term Global Assessment of Functioning; MD -0.66, 95% CI -3.60 to 2.28; 1 study; n=30; very low-quality evidence).
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