Child and adolescent electroconvulsive therapy: a case report

Systematic review: Electroconvulsive therapy for treatment-resistant mood disorders in children and adolescents

Electroconvulsive therapy (ECT) is a well-established treatment for adults with mood disorders. However, its use in child and adolescent populations is less common. At the same time, approximately 60% of child and adolescent patients do not respond satisfactorily to first-line treatments for mood disorders. Given the need for effective treatments for severe mood disorders in adolescents and the low use rate of ECT, this systematic review examines the existing literature on the effectiveness and adverse effect profile of ECT when used for treatment-resistant mood disorders in children and adolescents. Searches were conducted in Medline, Embase, and PsycInfo using search terms related to (1) children and adolescents, (2) mood disorders, and (3) ECT. Searches identified 1715 unique articles. The full text of 71 selected articles were reviewed, leading to 41 studies included in the study. A standardized data extraction tool was used to collect key information from each study (i.e. author and publication year, objectives, participants and setting, design, measures, clinical outcomes, and side effects). As most of the studies found were case series, the Joanna Briggs Institute Case Series Critical Appraisal tool was used to assess quality. Studies were summarized qualitatively by comparing findings across key study parameters. Our review identified 41 studies for inclusion. Twenty were case series, two were case-control studies, and nineteen were case reports. Overall treatment response rates ranged from 51 to 92%, with patients receiving an average of 12 treatments. Among studies with n > 30, response rates were largely 70-82% for depression and 87-90% for mania. Seven studies used the Mini-Mental State Exam and found no evidence of significant post-treatment cognitive impairment. The majority of side effects were minor and transient. Tardive seizure was reported in 4 (0.6%) patients. ECT was discontinued early due to side effects in 11 (1.5%) cases. 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.

A qualitative study of experience of parents of adolescents who received ECT

AIM OF THIS STUDY

To evaluate the experience of parents of adolescents who received ECT for severe mental illness.

METHODOLOGY

Using qualitative methods, 6 parents of 5 adolescents were interviewed by using a self-designed semi-structured interview after the completion of ECT course. The clinicians involved in the ECT procedure, i.e., seeking informed consent and administration of ECT were not aware about the study. All the interviews were recorded and the content was analysed and themes were generated.

RESULTS

Parents of all the 5 adolescents expressed that their children were considered for ECT only after the patient had not responded to medication and were unmanageable. Prior to ECT the treating doctors did explain to them about the ECT procedure, they were given information booklet and they were not coerced to consent for ECT. Some of the parents reported that they had dilemma prior to giving consent and were scared prior to the first ECT. However, as the clinical condition of their children improved, they felt that ECT was a good treatment. Majority of the parents felt that ECT was delayed for their children. When asked about restriction in use of ECT in children and adolescents, the parents expressed that it is important for law makers to understand the distress of the parents,when their children are acutely ill. They expressed that decision of administration of ECT must be left to the family and the treating clinicians.

CONCLUSION

Parents of adolescents considered for ECT are generally satisfied with the treatment procedure.

Electroconvulsive therapy use in adolescents: a systematic review

BACKGROUND

Considered as a moment of psychological vulnerability, adolescence is remarkably a risky period for the development of psychopathologies, when the choice of the correct therapeutic approach is crucial for achieving remission. One of the researched therapies in this case is electroconvulsive therapy (ECT). The present study reviews the recent and classical aspects regarding ECT use in adolescents.

METHODS

Systematic review, performed in November 2012, conformed to the PRISMA statement.

RESULTS

From the 212 retrieved articles, only 39 were included in the final sample. The reviewed studies bring indications of ECT use in adolescents, evaluate the efficiency of this therapy regarding remission, and explore the potential risks and complications of the procedure.

CONCLUSIONS

ECT use in adolescents is considered a highly efficient option for treating several psychiatric disorders, achieving high remission rates, and presenting few and relatively benign adverse effects. Risks can be mitigated by the correct use of the technique and are considered minimal when compared to the efficiency of ECT in treating psychopathologies.

Electroconvulsive therapy and transcranial magnetic stimulation: can they be considered valid modalities in the treatment of pediatric mood disorders?

Depression in children and adolescents is a severe and debilitating disorder and can be life-endangering. Even when it is not life-endangering, however, it has a grave impact on the quality of life of youngsters and their families, and interferes with normal growth and development. In recent years, the field of child psychiatry has become more aware of the limited applicability of data from the adult literature to children and adolescents and the limited resources that child psychiatrists have in treating depression. This awareness substantiates the need to define the place of electroconvulsive therapy and transcranial magnetic stimulation in the treatment of pediatric depression.