PURPOSE: To evaluate memory impairment associated with electroconvulsive therapy (ECT)–antipsychotic (AP) combination in comparison to AP monotherapy in schizophrenia. DESIGN AND METHODS: A systematic literature search of randomized controlled trial (RCTs) was performed. FINDINGS: Eleven RCTs that compared ECT–AP combination (n = 508) with AP monotherapy (n = 510) were analyzed. ECT–AP combination was associated with greater impairment than AP monotherapy in (1) endpoint memory quotient (MQ) of the Wechsler Memory Scale (WMS)–Revised at the end of the ECT course; and (2) picture recall, counting, recognition, and associative learning of the WMS. However, no group difference was found in MQ at 1 and 2 weeks post-ECT. PRACTICE IMPLICATIONS: The ECT–AP combination was associated with greater transient memory impairment compared to AP monotherapy.