Is electroconvulsive therapy an evidence-based treatment for catatonia? A systematic review and meta-analysis

Arnaud Leroy, Florian Naudet, Guillaume Vaiva, Andrew Francis, Pierre Thomas, Ali Amad

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


We aimed to review and discuss the evidence-based arguments for the efficacy of electroconvulsive therapy (ECT) in the treatment of catatonia. Randomized controlled trials (RCTs) and observational studies focusing on the response to ECT in catatonia were selected in PubMed, the Cochrane Library, Embase, and Current Controlled Trials through October 2016 and qualitatively described. Trials assessing pre-post differences using a catatonia or clinical improvement rating scale were pooled together using a random effect model. Secondary outcomes were adverse effects of anesthesia and seizure. 564 patients from 28 studies were included. RCTs were of low quality and were heterogeneous; therefore, it was not possible to combine their efficacy results. An improvement of catatonic symptoms after ECT treatment was evidenced in ten studies (SMD = −3.14, 95% CI [−3.95; −2.34]). The adverse effects that were reported in seven studies included mental confusion, memory loss, headache, or adverse effects associated with anesthesia. ECT protocols were heterogeneous. The literature consistently describes improvement in catatonic symptoms after ECT. However, the published studies fail to demonstrate efficacy and effectiveness. It is now crucial to design and perform a quality RCT to robustly validate the use of ECT in catatonia. Prospero registration information: PROSPERO 2016: CRD42016041660.

Original languageEnglish (US)
Pages (from-to)675-687
Number of pages13
JournalEuropean Archives of Psychiatry and Clinical Neuroscience
Issue number7
StatePublished - Oct 1 2018

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health
  • Biological Psychiatry
  • Pharmacology (medical)


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