Electroconvulsive Therapy in Children and Adolescents

Abstract

There is a lack of studies regarding the efficacy of electroconvulsive therapy (ECT) in children and adolescents. In this study, we aimed to assess benefits and harms of ECT in children and adolescents with major psychiatric diseases. We conducted a systematic search in PubMed, EMBASE, and PsycINFO for peer-reviewed articles written in English regarding the use of ECT as treatment for major psychiatric diseases in children and adolescents. This study consists of 192 articles, mostly case studies (n = 50), reviews and overview articles (n = 52), and retrospective studies (n = 30). We present an overview of evidence for ECT in children and adolescents with mood disorders, catatonia, schizophrenia, intellectual disability, self-injurious behavior, and other indications. This article is also a summary of international guidelines regarding the use of ECT in children and adolescents. We evaluated the overall quality of evidence by using Grading of Recommendations, Assessment, Development and Evaluations and found the overall level of evidence to be of low quality. There are no absolute contra indications for ECT in children and adolescents. Fears regarding cognitive dysfunction have not been reproduced in studies. Electroconvulsive therapy should be considered in severe, treatment-resistant mood disorders, catatonia, and schizophrenia, especially in older adolescents. High-quality studies are warranted to assess the efficacy of ECT, especially in these potentially life-threatening diseases.

Electroconvulsive Therapy in Children and Adolescents in Germany—A Case Series From 3 University Hospitals

“…However, there is a lack of studies on ECT in C/A psychiatry. The same conclusion was drawn in a review by Døssing and Pagsberg, 47 which gave an overview of 54 mostly single case studies, but also case series and retrospective studies.…”

Non-invasive brain stimulation for treating catatonia: a systematic review

“…Of these, three studies summarized the effects of ECT on patients with unrestricted catatonia ( 36 , 38 , 40 ) (i.e., all types of catatonia), and 11 studies described the benefits of ECT for catatonia patients with the following different etiologies: catatonic schizophrenia [two reviews ( 37 , 41 ), including 35 studies], autistic spectrum disorder [ASD; two reviews ( 32 , 42 )], malignant catatonia ( 31 ), benzodiazepine withdrawal ( 39 ), anti-N-methyl-d-aspartate (NMDA) receptor encephalitis ( 43 ), coronavirus disease 2019 ( 30 ) (COVID-19), and obsessive–compulsive disorder (OCD) ( 35 ). Additionally, one review focused on ECT for catatonia in children and adolescents ( 33 ), and another focused on catatonia in older adults ( 34 ).…”

Ketamine Augmentation of Electroconvulsive Therapy in an Adolescent Patient With Suicidal Ideation, Disordered Eating, and Type 1 Diabetes Mellitus

“…To the Editor R esearch on electroconvulsive therapy (ECT) in children and adolescent psychiatric patients remains limited, though its safety and efficacy appears similar to that in adults. 1 Catatonia and major depressive episodes are the only Food and Drug Administration-approved indications for ECT in children and adolescent psychiatric patients, but there is some evidence that ECT is useful for treating eating disorders (EDs). 2 Given the difficulty of treating EDs and their high morbidity and mortality, further research is needed on treatments such as ECT.…”

“…There are no RCTs of ECT in adolescents, nor RCTs of ketamine augmentation. 1 Lacking systematic evidence for adolescents, each psychiatric team must make decisions based on evidence in adults, recent treatment guidelines, and case reports. In our experience, ECT with or without ketamine augmentation may help adolescents with mood disorders and complex comorbidities.…”

“…Future research is needed to understand the benefits and limitations of ECT for pediatric patients. There are no RCTs of ECT in adolescents, nor RCTs of ketamine augmentation 1 . Lacking systematic evidence for adolescents, each psychiatric team must make decisions based on evidence in adults, recent treatment guidelines, and case reports.…”