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March 1990

Clozapine and Electroconvulsive Therapy-Reply

Arch Gen Psychiatry. 1990;47(3):291. doi:10.1001/archpsyc.1990.01810150091019

In Reply.—  Dr Fink states that 70% of the cases treated by the Clozaril Collaborative Study Group1 were failures after 6 weeks of treatment and might be better assigned to a trial of ECT plus neuroleptic. The point of my letter was that my clinical experience with clozapine provides abundant evidence that a number of treatmentresistant schizophrenic patients who have not responded to clozapine by 6 weeks will respond, sometimes dramatically, at subsequent periods. In my view, such patients should not be considered clozapine failures if there is no improvement by 6 weeks, but rather as possible responders who have not yet had an adequate trial. In short, just as clozapine clearly differs from typical neuroleptics in efficacy and side effects, it also differs in time course. I strongly believe that it is erroneous to apply the customary 6week trial period used for typical neuroleptic drugs to clozapine, based on

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