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ECT Surpasses Other Treatments in Refractory Schizophrenia

Key clinical point: Electroconvulsive therapy is tied to increased hippocampal volume in patients with drug-resistant schizophrenia, compared with pharmaceutical treatment.

Major finding: After 4 weeks, hippocampal volume increased significantly in all patients treated with ECT, compared with pharmaceutical therapy, and functional connectivity increased among the ECT patients who responded to the therapy.

Study details: The data come from a study of 21 adults with schizophrenia treated with ECT and 21 treated with pharmaceutical therapy.

Disclosures: The researchers had no financial conflicts to disclose. The study was funded by the National Natural Science Foundation of China, the Ministry of Science and Technology of China, and the SHSMU-ION Research Center for Brain Disorders.

Citation:

Jiang Y et al. Neuroimage Clin. 2019. doi: 10.1016/j.nicl.2019.102081.

Commentary:

ECT is known to improve schizophrenia symptoms among some patients. However, there are multiple gaps in our understanding of the biological underpinnings that may explain this effect, and whether changes are specific to ECT versus an overall phenomenon among patients with symptomatic improvement more broadly. Study findings align with previous reports of hippocampal volume increases following ECT in psychiatric disorders. The authors also compared differences between ECT and drug-only samples, as well as ECT responders versus non-responders. Results demonstrated hippocampal volume increase only in the ECT sample. Change appeared to occur in both ECT responders and non-responders. This finding suggests changes in hippocampal volume induced by ECT are not unique to patients with improved symptoms. While results need to be interpreted cautiously given the small sample and other methodological limitations, the focus on structural brain changes with ECT in schizophrenia is novel and may help to inform future neuromodulation research in schizophrenia.—Martha Sajatovic, MD, Professor of Psychiatry and of Neurology; Willard Brown Chair in Neurological Outcomes Research; Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine.