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Am J Psychiatry 1997; 154:595-602
Copyright © 1997 by American Psychiatric Association
Half a century of ECT use in young people
JM Rey and G Walter
Department of Psychological Medicine, University of Sydney, N.S.W., Australia. jrey@mail.usyd.edu.au
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.
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