Changes of metabolic parameters during electroconvulsive treatment of schizophrenia: Preliminary results

Authors


Electroconvulsive therapy (ECT) is used for treatment-resistant schizophrenia and affective disorders. For chronic effects, it was reported that ECT might be associated with weight loss in patients with depression.[1] In that paper, non-attempted significant weight loss (9–54 kg; no data for other metabolic parameters were reported) was observed during observations lasting from 10 months to 8 years. The authors discussed several potential explanations (discontinuation of antipsychotics, lower doses of medications, changes in lifestyle during periods of euthymia and more direct actions of ECT involving effects on leptin or serotonin receptors). For acute metabolic effects of ECT, it was reported that cholesterol and glucose levels are increased 20 min after ECT.[2] ECT may increase glucose levels via cortisol,[3] norepinephrine[4] or insulin.[5] The mechanisms linking ECT and changes in blood lipids are unknown. Also, there are no data for the effect of ECT on weight during short-term treatment or for patients with schizophrenia. We focused on short-term effects of ECT on metabolic parameters.

Thirteen Caucasian patients (nine men/four women, aged 28.9 ± 9.1 years) with treatment-resistant paranoid schizophrenia treated with ECT and antipsychotics (clozapine, quetiapine, risperidone or olanzapine) were studied. They had never received ECT prior to the study. Subjects signed informed consent in accordance with ethical committee approval.

Subjects had 12–15 (mean 14.5) bilateral ECT sessions administered three times a week. ECT was performed using a brief bipolar pulse from a constant-current Thymatron System IV machine (Somatics, Lake Bluff, IL, USA) with a standard low 0.5 program. Mean session energy was 29.3 ± 18.4%, mean session duration was 41.7 ± 22.7 s.

There were no changes in pre- or post-ECT results for abdominal circumference (96.9 ± 11.9 vs 95.0 ± 12.7 cm, P = 0.16), weight (80.8 ± 16.6 vs 79.4 ± 16.4 kg, P = 0.08), body mass index (26.8 ± 4.1 vs 26.2 ± 3.8 kg/m2, P = 0.07), fasting blood levels of cholesterol (198.3 ± 43.1 vs 187.1 ± 33.3 mg/dL, P = 0.21), high-density lipoprotein (39.8 ± 12.6 vs 39.5 ± 9.8 mg/dL, P = 0.47), low-density lipoprotein (122.1 ± 26.8 vs 119.8 ± 25.6 mg/dL, P = 0.38), triglycerides (162.6 ± 91.1 vs 146.6 ± 71.0 mg/dL, P = 0.21), glucose (107.4 ± 48.5 vs 108.5 ± 49.1 mg/dL, P = 0.60), 24-h locomotor activity (measured using Omron HJ-303 tri-axis pedometer: 10050.2 ± 8585.7 vs 11982.1 ± 10023.2 steps/day, P = 0.74), basal metabolic rate (Mifflin-St. Jeor formula: 1701.5 ± 262.5 vs 1687.3 ± 266.9 kcal/day, P = 0.08), daily energy expenditure (Harris–Benedict formula: 2579.3 ± 495.7 vs 2498.5 ± 462.8 kcal/day, P = 0.20) or daily energy balance (daily calories intake minus daily energy expenditure: 89.9 ± 609.5 vs 170.7 ± 536.8 kcal/day, P = 0.20). Systolic (122.5 ± 7.2 vs 110.1 ± 13.9 mm Hg, P = 0.009) and diastolic blood pressure (83.1 ± 13.2 vs 70.5 ± 12.0 mm Hg, P = 0.006) changed, probably because patients required antihypertensive treatment if they were not on such treatment.

These results should be interpreted with caution because of the study's limitations: the low number of subjects, short duration of the study (which might be too short for detectable changes to occur), the lack of data for maintenance treatment and the concomitant use of antipsychotics with highly detrimental metabolic effects. Further studies of larger samples evaluating longer duration of treatment (including maintenance ECT) are required to confirm the stability of metabolic parameters in patients with schizophrenia treated with ECT.

The author is (partially) supported by the Healthy Ageing Research Centre project (REGPOT-2012-2013-1, 7FP). The author declares no conflict of interest.

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