OBJECTIVE: Pharmacological treatments for certain psychiatric disorders
in young people are often ineffective and may cause major side effects;
thus, it is important to investigate other treatments. This article reviews
the literature on the efficacy and safety of ECT in this age group and
examines the evidence for the suggestion that it may be used
inappropriately. METHOD: All studies published in English and other
languages on the use of ECT in persons 18 years of age or younger were
obtained. The reports were systematically reviewed and rated according to
the quality of the information in several domains, yielding an overall
quality score for each study. Individual cases from each report were then
examined and grouped according to diagnosis and response to ECT. RESULTS:
Sixty reports describing ECT in 396 patients were identified; most (63%)
were single case reports. The overall quality was poor but improved in the
more recent studies. There were no controlled trials. Rates of improvement
across studies were 63% for depression, 80% for mania, 42% for
schizophrenia, and 80% for catatonia. Serious complications were very rare,
whereas minor, transient side effects appeared common. CONCLUSIONS: ECT in
the young seems similar in effectiveness and side effects to ECT in adults.
However, this conclusion is qualified by the lack of systematic evidence.
More research and education of professionals and the public are needed. It
is suggested that ECT registers be set up, that surveys and controlled
trials be conducted, and that seizure thresholds, the optimal anesthetic,
effects of concurrent medications, and cognitive consequences of ECT in the
young be investigated.