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

  • Arnaud LeroyEmail author
  • Florian Naudet
  • Guillaume Vaiva
  • Andrew Francis
  • Pierre Thomas
  • Ali Amad
Original Paper


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


Catatonia Electroconvulsive therapy RCT Evidence-based medicine 



The authors wish to thank Drs. Itziar Flamarique, Neeraj Gill, Kumar Girish, Sandeep Grover, Kotaro Hatta, Rakesh Karmacharya, Vivek Haridas Phutane, and Jagadisha Thirthalli for sharing their data and information about their respective studies.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest regarding this study. No authors received support from any company for the submitted work. AA, GV and PT have relationships (travel/accommodation expenses covered/reimbursed) with Otsuka, Lundbeck, Servier and Janssen. FN has relationships (travel/accommodation expenses covered/reimbursed) with Servier, BMS, Lundbeck, and Janssen, who might have an interest in the work submitted in the previous 3 years. No author’s spouse, partner, or children have any financial relationships that could be relevant to the submitted work. None of the authors has any non-financial interests that could be relevant to the submitted work.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Arnaud Leroy
    • 1
    Email author
  • Florian Naudet
    • 2
  • Guillaume Vaiva
    • 1
  • Andrew Francis
    • 3
  • Pierre Thomas
    • 1
  • Ali Amad
    • 1
    • 4
  1. 1.CNRS UMR 9193-PsyCHIC-SCALab, & CHU Lille, Department of PsychiatryUniv. LilleLilleFrance
  2. 2.INSERM Centre d’Investigation Clinique 1414Centre Hospitalier Universitaire de RennesRennesFrance
  3. 3.Department of PsychiatryPenn State Medical SchoolHersheyUSA
  4. 4.Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK

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