If you are of a certain age, the thought of electroconvulsive (electroshock) therapy (ECT) may make you shudder in fear. Outside of the U.S., ECT is often highly regarded as effective and the ‘gold standard’ for treating adults with treatment-resistant mood disorders. In the U.S., however, there is still concern about it in some quarters, but see Dr. Joseph Goldberg’s article about how ECT is both heroic and effective and we need to keep it in our arsenal for treating adults.

But is ECT safe and effective for treating mood disorders in children and teens who have not responded to other treatments? Drs. Castaneda-Ramirez, Bruges-Boude, and their colleagues noted that 60% of children and youth with mood disorders do not respond to first-line treatments. That is a significant percentage of youth who are suffering without effective treatment.  Based on their inclusion criteria, the researchers reviewed 41 ECT studies in their study: 20  were case series, 2 were case-control studies, and 19 were case reports.

According to their report, the overall treatment response rates ranged from 51 to 92%. Where there were more treatment sessions, response rates were largely 70-82% for depression and 87-90% for mania. In the small number of studies that assessed potential post-treatment cognitive impairment, no evidence of significant impairment was reported. The majority of adverse effects from ECT were generally minor and transient, although treatment was discontinued early in 1.5% of cases due to adverse effects. No fatalities were reported.

“Our data suggest that ECT is safe and effective for the treatment of mood disorders in child and adolescent populations, and should be considered in severe and treatment-refractory cases. Controlled studies with objective measures and long-term follow-up are needed to advance the evidence base,” the researchers conclude.

Reference:

Castaneda-Ramirez S, Becker TD, Bruges-Boude A, Kellner C, Rice TR. Systematic review: Electroconvulsive therapy for treatment-resistant mood disorders in children and adolescents. Eur Child Adolesc Psychiatry, 2022 Jan 9. doi: 10.1007/s00787-022-01942-7.