What is the role of electroconvulsive therapy (ECT) in the treatment of children and adolescents?

Updated: Sep 24, 2019
  • Author: Mehul V Mankad, MD; Chief Editor: Dennis M Popeo, MD  more...
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Answer

Many child and adolscent psychiatrists have little training or knowledge of ECT. The American Academy of Child and Adolescent Psychiatry published an overview of ethical issues in January 2012. The guidelines suggest that written, informed consent be obtained from the parents and that a second opinion on the necessity of ECT be obtained from an independent psychiatrist not involved in the treatment of the minor. [72]

Diagnostic considerations for ECT in an adolescent patient [73] include severe or persistent major depression or mania [74] with or without psychotic features, schizoaffective disorder, schizophrenia, catatonia, [75] or neuroleptic malignant syndrome. The symptoms must be severe, persistent, and disabling.

Before considering ECT in children and adolescents, lack of treatment response should be documented. Lack of treatment response is defined as failure to respond to at least 2 adequate trials of appropriate psychopharmacological agents accompanied by other appropriate treatment modalities. [73]  

The response rate for mood disorders to ECT in the pediatric population is 63% and 80% for catatonia according to the largest review of ECT use in the pediatric population. [76]  A more recent systematic review from 2013 found similar results. [77]


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