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      Electroconvulsive therapy use in adolescents: a systematic review

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          Abstract

          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.

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          Most cited references31

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          Electroconvulsive therapy and its different indications

          Thomas Baghai, Hans-Jurgen Möller (2008)
          In spite of recent developments in the pharmacotherapy of depressive disorders, the delay until clinical improvement can be achieved, and the considerable rate of nonresponse and nonremission, are major problems which remain unresolved. Electroconvulsive therapy (ECT) is a nonpharmacoloqic bioloqical treatment which has been proven to be a highly effective treatment option, predominantly for depression, but also for schizophrenia and other indications. Though there is a lack of controlled investigations on long-term treatments, ECT can also be used for relapse prevention during maintenance therapies. The safety and tolerabitity of electroconvulsive treatment have been enhanced by the use of modified stimulation techniques and by progress in modern anesthesia. Thus, today a safe treatment can also be offered to patients with higher somatic risks, ECT still represents an important option, especially in the therapy of treatmentresistant psychiatric disorders after medication treatment failures. Earlier consideration of ECT may reduce the rate of chronic and difficult-to-treat psychiatric disorders.
          Article 0 comments Cited 26 times – based on 0 reviews     Review now
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            Practice parameter for use of electroconvulsive therapy with adolescents.

            Jeffrey Kutcher, Oscar Bukstein, P Knapp … (2004)
            Electroconvulsive therapy (ECT) may be an effective treatment for adolescents with severe mood disorders and other Axis I psychiatric disorders when more conservative treatments have been unsuccessful. ECT may be considered when there is a lack of response to two or more trials of pharmacotherapy or when the severity of symptoms precludes waiting for a response to pharmacological treatment. The literature on ECT in adolescents, including studies and case reports, was reviewed and then integrated into clinically relevant guidelines for practitioners. Mood disorders have a high rate of response to ECT (75%-100%), whereas psychotic disorders have a lower response rate (50%-60%). Consent of the adolescent's legal guardian is mandatory, and the patient's consent or assent should be obtained. State legal guidelines and institutional guidelines must be followed. ECT techniques associated with the fewest adverse effects and greatest efficacy should be used. The presence of comorbid psychiatric disorder is not a contraindication. Systematic pretreatment and posttreatment evaluation, including symptom and cognitive assessment, is recommended.
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              ECT in bipolar and unipolar depression: differences in speed of response.

              Roger Daly, S Peyser, Steven P Roose … (2001)
              There is sparse evidence for differences in response to electroconvulsive therapy (ECT) between patients with bipolar or unipolar major depression, with virtually no information on speed of response. We contrasted a large sample of bipolar (BP) and unipolar (UP) depressed patients in likelihood and rapidity of clinical improvement with ECT. Over three double-blind treatment protocols, 228 patients met Research Diagnostic Criteria for UP (n = 162) or BP depression (n = 66). Other than lorazepam PRN (3 mg/day), patients were withdrawn from psychotropics prior to the ECT course and until after post-ECT assessments. Patients were randomized to ECT conditions that differed in electrode placement and stimulus intensity. Symptomatic change was evaluated at least twice weekly by a blinded evaluation team, which also determined treatment length. Patients with BP and UP depression did not differ in rates of response or remission following the ECT course, or in response to unilateral or bilateral ECT. Degree of improvement in Hamilton Rating Scale for Depression scores following completion of ECT was also comparable. However, BP patients received significantly fewer ECT treatments than UP patients, and this effect was especially marked among bipolar ECT responders. Both BP I and BP II patients showed especially rapid response to ECT. The BP/UP distinction had no predictive value in determining ECT outcome. In contrast, there was a large effect for BP patients to show more rapid clinical improvement and require fewer treatments than unipolar patients. The reasons for this difference are unknown, but could reflect a more rapid build up of anticonvulsant effects in BP patients.
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Nádia NR Lima
                Vânia B Nascimento
                Jorge AC Peixoto
                Marcial M Moreira
                Modesto LR Neto
                José C Almeida
                Carlos AC Vasconcelos
                Saulo A Teixeira
                Jucier G Júnior
                Francisco TC Junior
                Diego DM Guimarães
                Aline Q Brasil
                Jesus S Cartaxo
                Marco Akerman
                Alberto OA Reis
                Journal
                Journal ID (nlm-ta): Ann Gen Psychiatry
                Journal ID (iso-abbrev): Ann Gen Psychiatry
                Title: Annals of General Psychiatry
                Publisher: BioMed Central
                ISSN (Electronic): 1744-859X
                Publication date Collection: 2013
                Publication date (Electronic): 30 May 2013
                Volume: 12
                Page: 17
                Affiliations
                [1 ]Health Sciences Postgraduate Program, Faculty of Medicine, ABC Foundation, Santo André, São Paulo 09060-650, Brazil
                [2 ]Research Group CNPq/UFC: Information Technology, Communication, Narrativity, Society and Plural Identities, Federal University of Ceará (UFC), Juazeiro do Norte, Ceará 63.048-060, Brazil
                [3 ]Federal University of Campina Grande (UFCG), Cajazeiras, Paraíba 58900-000, Brazil
                [4 ]Neuropsychiatry and Behavioral Sciences Postgraduate Program, Federal University of Pernambuco (UFPE), Recife, Pernambuco 50.670-420, Brazil
                [5 ]Faculty of Medicine, Federal University of Ceará (UFC), Barbalha, Ceará 63180-000, Brazil
                [6 ]Public Health Faculty, University of São Paulo (USP), São Paulo 01246-904, Brazil
                Article
                Publisher ID: 1744-859X-12-17
                DOI: 10.1186/1744-859X-12-17
                PMC ID: 3680000
                PubMed ID: 23718899
                SO-VID: be2d7720-66e5-4705-aa4b-ad36a367095e
                Copyright © Copyright ©2013 Lima et al.; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 26 December 2012
                Date accepted : 21 May 2013
                Categories
                Subject: Review

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry

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