8.4 OUTCOMES OF YOUTH TREATED WITH ECT

Abstract

The use of ECT in children and adolescents is based on a limited evidence base in the medical literature. Our objective is to review the available evidence for the safety and efficacy of ECT in pediatric patients with refractory mental health disorders. In this session, we review the available high-quality literature of ECT use in pediatric patients. We emphasize a recent study of youth treated with ECT at a single US academic medical center. Using a retrospective chart review, clinical outcomes from all patients aged 18 years and younger who received ECT at the University of Utah from 1985 through 2016 were assessed. For each patient record, 3 short-term clinical outcomes were evaluated: 1) response on the Clinical Global Impression-Improvement (CGI-I) scale; 2) number of treatments administered; and 3) reported side effects. Baseline characteristics were tested as predictors of clinical outcomes. A total of 107 youth (ages 10-18 years; 46% female) received ECT for a mood disorder, psychotic disorder, catatonia, or neuroleptic malignant syndrome. Mood disorders represented the most common diagnoses (DSM-IV-TR or DSM-5), including MDD (76 patients, 71% of the sample) and bipolar disorder (23 patients, 21% of the sample). The rate of response (much improved or very much improved) for the entire cohort was 77%. The mean number of treatments administered was 10.5. The most commonly reported side effects were headache (75%) and memory problems (65%). Although one patient experienced tardive seizures, there were no deaths or serious injuries. Clinical response was not predicted by age, sex, or clinical features. These data suggest that ECT is a safe and effective treatment for children and adolescents with certain severe mental illnesses. ECT outcomes and side effects were similar to those reported in adults, particularly for patients aged 15 to 18 years, for whom there are the most data. Despite its utility, ECT continues to suffer from considerable stigma, and access to ECT for pediatric patients is often challenging. Important areas for future development include increased dissemination of ECT outcomes, examination of predictors of treatment response in larger cohorts, and public advocacy to improve timely and equitable access to care for pediatric patients in need.