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Meta-Analysis
. 2026 Jan 16;52(1):sbae169.
doi: 10.1093/schbul/sbae169.

Relapse Following Electroconvulsive Therapy for Schizophrenia: A Systematic Review and Meta-analysis

Nobuatsu Aoki  1   2   3 , Aran Tajika  4 , Taro Suwa  5 , Hirotsugu Kawashima  5 , Kazuyuki Yasuda  6 , Toshiyuki Shimizu  1 , Niina Uchinuma  6 , Hirotaka Tominaga  7 , Xiao Wei Tan  8 , Azriel H K Koh  8 , Phern Chern Tor  8 , Stevan Nikolin  2   3 , Donel Martin  2   3 , Masaki Kato  1 , Colleen Loo  2   3 , Toshihiko Kinoshita  1 , Toshi A Furukawa  4 , Yoshiteru Takekita  1
Affiliations
Meta-Analysis

Relapse Following Electroconvulsive Therapy for Schizophrenia: A Systematic Review and Meta-analysis

Nobuatsu Aoki et al. Schizophr Bull. .

Abstract

Background: Evidence regarding schizophrenia relapse following acute electroconvulsive therapy (ECT) is sparse compared with that for depression, and we have no clear consensus on relapse proportions. We aimed to provide longitudinal information on schizophrenia relapse following acute ECT.

Study design: This systematic review and meta-analysis included randomised controlled trials (RCTs) and observational studies on post-acute ECT relapse and rehospitalization for schizophrenia and related disorders. For the primary outcome, we calculated the post-acute ECT pooled relapse estimates at each timepoint (3, 6, 12, and 24 months post-acute ECT) using a random effects model. For subgroup analyses, we investigated post-acute ECT relapse proportions by the type of maintenance therapy.

Study results: Among a total of 6413 records, 29 studies (3876 patients) met our inclusion criteria. The risk of bias was consistently low for all included RCTs (4 studies), although it ranged from low to high for observational studies (25 studies). Pooled estimates of relapse proportions among patients with schizophrenia responding to acute ECT were 24% (95% CI: 15-35), 37% (27-47), 41% (34-49), and 55% (40-69) at 3, 6, 12, and 24 months, respectively. When continuation/maintenance ECT was added to antipsychotics post-acute ECT, the 6-month relapse proportion was 20% (11-32).

Conclusion: Relapse occurred mostly within 6 months post-acute ECT for schizophrenia, particularly within the first 3 months. Relapse proportions plateaued after 6 months, although more than half of all patients could be expected to relapse within 2 years. Further high-quality research is needed to optimise post-acute ECT treatment strategies in patients with schizophrenia.

Keywords: electroconvulsive therapy; meta-analysis; rehospitalisation; relapse; schizophrenia; systematic review.

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Conflict of interest statement

NA reports grants from the Japan Society for Promotion of Science and the Japanese Society of Clinical Neuropsychopharmacology, during the conduct of the study; has received honoraria from Lundbeck and Sumitomo Pharma, outside the submitted work. AT has received honoraria from Eisai, Janssen, Meiji-Seika Pharma, Mitsubishi Tanabe, Otsuka, Shionogi, Sumitomo Pharma, and Takeda Pharmaceutical. TS reports grants from Shionogi; and has received honoraria from EA Pharma, Otsuka, Sumitomo Pharma, Takeda, and Viatris Pharmaceutical, outside the submitted work. HK has received honoraria from Lundbeck, Otsuka, and Sumitomo Pharma. KY has received honoraria from Sumitomo Pharma, Otsuka, Eisai, MSD, and Viatris Pharmaceutical, outside the submitted work. ToS has received honoraria from Janssen, Meiji-Seika, Mochida Pharmaceutical, and Sumitomo Pharma, outside the submitted work. NU has received honoraria from Eisai, Janssen, Lundbeck, Otsuka, Sumitomo Pharma, and Viatris, outside the submitted work. DM has received honoraria for consultancy work from Douglas Pharmaceuticals, outside the submitted work. MK has received consulting fees from Lundbeck, Otsuka, Shionogi, Sumitomo Pharma and Takeda Pharma; honoraria from Eisai, Eli Lilly, Janssen, Kyowa Pharmaceutical, Lundbeck, Meiji-Seika Pharmaceutical, Mitsubishi Tanabe, MSD, Ono Pharmaceutical, Otsuka, Pfizer, Shionogi, Sumitomo Pharma, Takeda Pharmaceutical and Viatris, outside the submitted work. CL has received honoraria as an advisor board member from Douglas Pharmaceuticals and book royalties from Springer, outside the submitted work. TK has received honoraria from Eisai, Janssen, Meiji-Seika Pharma, Otsuka, and Sumitomo Pharma, outside the submitted work. TAF reports personal fees from Boehringer Ingelheim, Daiichi Sankyo, DT Axis, Kyoto University Original, Shionogi, SONY, and UpToDate, and a grant from Shionogi, outside the submitted work; In addition, TAF has patents 2020-548587 and 2022-082495 pending, and intellectual properties for Kokoro-app licensed to Mitsubishi Tanabe. YT reports grants from the Japan Society for Promotion of Science; and has received honoraria from Boehringer Ingelheim, Daiichi Sankyo, Eisai, Janssen, Lundbeck, Meiji-Seika, Novartis, Ono Pharmaceutical, Otsuka, Sumitomo Pharma, Teijin Pharma and UCB Japan, outside the submitted work. NA, TS, HK, KY, and YT are ECT committee members of the Japanese Society of General Hospital Psychiatry. TS and YK are Psychiatric Devices committee members of the Japanese Society of Psychiatry and Neurology. All other authors declare no competing interests.

Figures

Figure 1.
Figure 1.
Search and Selection Process. PRISMA Flow Diagram. *242 Records Without Available Data, 79 Trial Registries Without Results, 29 Non-ECT Studies, and 19 Records Not Involving Patients with Schizophrenia and Related Disorders. †Reasons for Exclusion Detailed After Full-Text Screening are Described in Supplementary Table S2 (pp. 13-15). ECT, Electroconvulsive Therapy
Figure 2.
Figure 2.
Forest Plot: Pooled Relapse Proportion Estimates at 3, 6, 12, and 24 Months After Acute ECT. ECT, Electroconvulsive Therapy
Figure 2.
Figure 2.
Forest Plot: Pooled Relapse Proportion Estimates at 3, 6, 12, and 24 Months After Acute ECT. ECT, Electroconvulsive Therapy
Figure 3.
Figure 3.
Pooled Relapse Proportion Estimates From APs Alone and C/M-ECT + APs Groups at 3, 6, 12, and 24 Months. The Size of Each Circle is Proportional to the Total Number of After Acute ECT Patients at the Start of all the Studies Contributing to That Pooled Estimate. Aps, Antipsychotics; C/M-ECT, Continuation/Maintenance ECT; ECT, Electroconvulsive Therapy
See this image and copyright information in PMC

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