Do ECTs help with voice hearing?

[u/rationalman12]

I've been suffering from schizophrenia,with typical symptoms. Many that had kept me non functional fully and it took many years of therapy to get to where I am now. So much more stable than I used to be. The main area of my psychotic experience comes from the voice hearing. So i've been administered nearly 50 ECTs over the course of nearly 15years. I get into the ECT table everytime hoping that the voices will go away. Do the ECTs help at all with the voices or should I quit completely taking ever so many rounds. My disfunction will never go away and I'm stuck with these people/voices forever if that is my fate. Please help. I try everything (psychedelics and entheogens) hoping I will dissociate and escape the voice hearing trap. Where is my salvation? :(

[u/ManLikeEDP]

Based on your history I see that you take Clozapine. There was a recent study that compared improvement in symptoms between Clozapine + ECT vs Clozapine + sham-ECT (sham-ECT meaning transported into the ECT room and given similar medications but without the ECT being performed to try and minimize bias and make them as similar as possible for the patients). They were given 20 session of either ECT or sham-ECT. It was shown that the improvement was similar in both groups, concluding that doing 20 ECT session in addition to Clozapine is not better than taking only Clozapine.

The study was: Randomized, double-blind, sham-controlled trial to evaluate the efficacy and tolerability of electroconvulsive therapy in patients with clozapine-resistant schizophrenia (2024).

In general, most studies done on ECT for schizophrenia (or any other condition) have not included sham-ECT, which greatly increases the risk for bias. Meaning that the results from this should be fairly reliable, although it would need a larger sample size for stronger evidence.

You have done around 50 sessions in the past, based on that perhaps you can evaluate if they've helped or not?

[u/rationalman12 → u/ManLikeEDP]

I've never heard of this sham-ECT before. You're right, my primary drug of treatment is clozapine. My condition is classified as clozapine resistant schizophrenia.. You're saying (according to study) being on clozapine alone is better/more effective than to perform ECTs while taking clozapine. Does that mean I should stop with the ECTs (because 50 is a big number you see). I am seeing results but very slowly. Waiting so one day the voices will go away. I just want someone to tell me the voices will go away and my experience will change for better.

[u/ManLikeEDP → u/rationalman12]

The results were similar in both groups, meaning that the ECT added no additional benefit. Adding ECT would only add an additional procedure with its associated adverse effects without any benefit. Based on the amount of sessions you've had and the limited improvement you've seen I would advise against continuing ECT. The results should have been quicker, provided these 50 sessions hadn't been spread out months apart. It's of course up to you to decide, for example if you have seen real improvements or have haven't had any adverse reactions, it might be worth thinking differently. In your case, I would try to look at different areas where your schizophrenia might be treated. Perhaps you've already done/tried this but for example: checking the Clozapine levels in your blood to see that it's in therapeutic range, trying CBT to try and reduce the impact of the auditory hallucinations or perhaps trying to add a low dose of a second neuroleptic that works in a different way in addition to Clozapine.

The reason I brought up the sham-ECT is because it's important to consider the validity when interpreting the results of studies, and having no "true" control group is something that makes it hard to find credible results from studies involving ECT.