Electroconvulsive therapy effective for certain severe psychiatric illnesses in youth

Electroconvulsive therapy appeared safe and effective for treating certain severe psychiatric illnesses among children and adolescents, according to results of a retrospective cohort study published in Journal of Clinical Psychiatry.

“The evidence supporting the use of ECT in youth is growing, but it remains based primarily on case reports and case series,” Matthew D. Pierson, MD, of the department of psychiatry at the University of Utah, and colleagues wrote. “Four relatively recent retrospective studies, with sample sizes ranging from 13 to 51 (n= 111 total), suggest that ECT is safe and effective for youth with severe affective and psychotic disorders. What is not well described, however, is the value of demographic and baseline clinical data for predicting outcomes for youth treated with ECT.”

To address this research gap, the researchers conducted a retrospective chart review in which they analyzed data of 107 youth aged 10 to 18 years who received ECT for a mood disorder, psychotic disorder, catatonia or neuroleptic malignant syndrome at a single U.S. academic medical center between 1985 and 2016. Patients’ most common diagnoses according to DSM-IV-TR or DSM-5 criteria were major depressive disorder (n = 76) and bipolar disorder (n = 23). Pierson and colleagues assessed response on the Clinical Global Impressions-Improvement scale, number of treatments administered and reported side effects for each patient record. Further, they evaluated baseline characteristics as predictors of clinical outcomes.

Results showed the entire cohort had a rate of response of 77%, with a mean of 10.5 treatments administered. Headache (75%) and memory problems (65%) were the most frequent side effects. A total of one patient had tardive seizures and no deaths or serious injuries occurred. Age, sex or clinical features did not predict clinical response.

“This study provides retrospective evidence suggesting ECT is a safe and effective treatment for youth with certain severe psychiatric illnesses,” Pierson and colleagues wrote. “The data presented in this study show that, particularly for patients aged 15 to 18 years, for whom there are the most data, those with severe affective disorders and catatonia respond to ECT similarly to adults and that psychiatrists should consider ECT in their clinical decision making for these patients. Whether younger children, or youth with schizophrenia spectrum disorders, respond similarly to adults remains unclear.”