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March 1990

Clozapine and Electroconvulsive Therapy

Author Affiliations

Department of Psychiatry State University of New York at Stony Brook Stony Brook, NY 11794

Arch Gen Psychiatry. 1990;47(3):290-291. doi:10.1001/archpsyc.1990.01810150090018

To the Editor.—  Meltzer,1 in the July 1989 issue of the Archives, suggests that the benefits of clozapine in neuroleptic-resistant schizophrenia may be extended by continuing therapy for up to 52 weeks. He reports that 16 (31%) of 51 of his patients achieved the response criterion (20% or more decrease in Brief Psychiatric Rating Scale score) by 6 weeks. He states that "using a 50% or lower decrease in the total Brief Psychiatric Rating Scale score, we have found 20 responders with up to 12 months of treatment," an additional 4 patients over the 6-week response rate.Meltzer estimates that increased exposure to the risks of clozapine are warranted, but he does not give the risk experience, which decreases the persuasiveness of his argument.It would be carping to complain that the Meltzer risk-benefit analysis of exposure to clozapine is incomplete, since the patients treated are so ill,