ECT and clozapine combination and mania: a case report

Electroconvulsive therapy (ECT) and clozapine combination may predict resistant schizophrenia in literature although data is limited to case reports. Research is indicated as safe and effective on the combination of ECT and clozapine. Bloch et al. have described seizures extended with this combination. Kumar et al. reported a patient that develops delirium after combination of ECT and clozapine. ECT and clozapine combination provided this improvement long term consequences are not clear, it is suggested that the effect is sustainable. This article presented a patient who developed manic episode then 600mg/day clozapine and bilateral ECT combination. A 36-year-old, single, male patient displaying disorganized behavior, irritability, treatment noncompliance, was admitted to the hospital. The first symptoms that appeared 20 years ago, were self-talking, hearing voices, she began as the self-orientation. The patient with schizophrenia was treated 5 times. He does not have any organic disease and alcohol use disorder. There was no family history of mental illness. We could not learn the drugs he used before. Since 2012, patient has been receiving clozapine 600 mg/day, risperidone 8mg/day, biperidene 4mg/day, zuclopenthixol depot. After implementation of planned ECT sessions irritability, aggression, hyperactivity, insomnia and grandiosity developed and ECT treatment was discontinued. His treatment was continued with medical treatment. Baseline Young Mania Rating Scale score was 26. His manic symptoms were decreased within next two weeks. Following ECT applications, manic episodes were reported in the literature. However, while ECT and clozapine combining has not been reported any manic episode. In resistant schizophrenia, clozapine and ECT combination should be used with caution.