Electroconvulsive Treatment in Adolescents with Pharmacotherapy–Refractory Depression

Department of Psychiatry, University of Michigan, Ann Arbor, USA.
Journal of Child and Adolescent Psychopharmacology (Impact Factor: 2.93). 12/1996; 6(4):259-71. DOI: 10.1089/cap.1996.6.259
Source: PubMed


The effectiveness and safety of ECT in pharmacotherapy-refractory depression was examined in 11 hospitalized adolescents (ages 16.3 +/- 1.7 years, 10 females) with a primary DSM-III-R diagnosis of mood disorder, which had failed to respond to three or more adequate trials of antidepressant pharmacotherapy. After a thorough diagnostic evaluation, patients received a course of ECT involving 11.2 +/- 2.0 (range 8-15) administrations. ECT was commenced with bilateral treatment in 2 adolescents and nondominant right electrode placement in 9 patients; 5 of the 9 patients were subsequently changed to bilateral treatment. All 11 patients improved to a clinically significant degree. Significant improvements were noted in scores on the Children Depression Rating Scale-Revised (CDSR-R) and the Global Assessment of Functioning Scale (GAF) (p < 0.05). Euthymia, defined as CDRS-R score < or = 40, was achieved by 64% (7/11) of patients. The Mini-Mental State Examination showed no significant decline in cognitive functioning. Neuropsychological testing completed in 5 subjects both before ECT and 1-5 days after the last treatment, indicated a significant decline in attention, concentration, and long-term memory search. Minor side effects, experienced within the first 12 hours of treatment, were headache (80% of patients) and nausea/vomiting (64%). The potentially serious complication of tardive seizure (after full recovery of consciousness) occurred in 1 adolescent. Prolonged seizures (> 2.5 minutes) were noted in 7 of the 11 patients (9.6% of the 135 ECT administrations). Pending further research on ECT in youth, it is recommended that ECT should only be administered to youth in hospital settings, that all regularly administered psychotropic medications (including antidepressants) be discontinued before ECT and restarted after the final administration of ECT, and that physicians be aware that 12 treatments are usually sufficient, but that 15 treatments may occasionally be necessary for treating depressed adolescents. With the understanding that scientific evaluation of ECT in youth is lacking, it appears that ECT can be an effective and relatively safe treatment for depressed adolescents who have failed to respond to antidepressant pharmacotherapy.

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    • "Similarly, Moise and Petrides 27 described 10 of their 13 subjects as responders. One obvious limitation of publications by Walter and Rey (1997), Ghaziuddin et al (1996), and Moise and Petrides (1996) is their failure to make a clear distinction between response (50% improvement) and remission (minimal or absent symptoms ) and the lack of follow-up data. Nevertheless, adult studies, which make this distinction, find high remission rates varying between 50% to 80%, 28 and even a much higher rate of 97% was reported among adults with unipolar depression. "
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    ABSTRACT: Retrospective data are presented for 6 adolescents ranging in age from 14 to 17 years, who were diagnosed with severe treatment-resistant major depression (TRD). Subjects were treated with one or more index courses of electroconvulsive therapy (ECT) followed by continuation ECT (C-ECT, up to 6 months of ECT) or maintenance ECT (M-ECT; ECT beyond 6 months) when necessary. Electroconvulsive therapy was continued until remission or until minimal residual symptoms were evident. Pharmacotherapy and psychotherapy were reintroduced during C-ECT or M-ECT. Premorbid functioning was achieved by 5 of 6 cases. Cognitive deficits were not evident. In fact, comparison of pre-ECT and post-ECT neuropsychological functioning revealed a trend toward improved auditory and verbal memory on most of the results. We concluded that C-ECT and M-ECT are useful and safe treatment strategies for selected adolescents with severe treatment-resistant depression, and symptom remission may be achieved without experiencing cognitive impairment.
    The journal of ECT 06/2011; 27(2):168-74. DOI:10.1097/YCT.0b013e3181f665e4 · 1.39 Impact Factor
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    • "La eficacia descrita, todo y que varía según los diferentes estudios, es similar a la descrita en adultos, excepto para la depresión psicótica, donde se ha observado una eficacia menor y similar a la observada en la esquizofrenia, que podría atribuirse a la dificultad de discriminar entre ambas patologías en estas edades. En los estudios revisados (Domenech, 2004; Rey, 1997; Schneeckloth, 1993; Ghaziuddin 1996; Moise, 1996; Strober 1998; Duffet 1999; Ghaziuddin, 2000; Cohen, 2002; Etain, 2001) se describen los siguientes índices de eficacia: depresión mayor ( "
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    • "ment across studies were 63% for depression, 80% for mania, 42% for schizophrenia, and 80% for catatonia. Ghaziuddin et al. (1996) and Strober et al. (1998) conducted open prospective studies on 11 and 10 adolescents, respectively, who suffered from severe depression resistant to pharmacotherapy, and documented significant improvement following ECT in 11 and 9 of them, respectively . Other studies (Duffett et al., 1999; Walter and Rey, 1997) involving relatively small numbers of participants (12 and 42, respectively) showed that the respective remission rates following ECT were 75% and 51%. "
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    ABSTRACT: Information on the indications, technique, and effectiveness of electroconvulsive therapy (ECT) in adolescent patients is scarce. The recommendations for the use of ECT in this age group are similar to those in adults. This study compares the experience with ECT in the two age groups in the same community psychiatric institution, which adheres to the accepted protocols for diagnosis and treatment. The files of 24 consecutive adolescent patients treated in an ECT unit located in the center of Israel in the years 1991-1995 were retrospectively examined, and the findings were compared with those in 33 adult patients who started their ECT course on the same day. The technique for applying ECT was essentially the same in the two age groups. ECT was equally effective for adolescents and adults (58% in each group achieved remission). The main difference was the diagnosis for which patients were referred: most of the adolescents were in the "psychotic spectrum, whereas most of the adults were in the "affective spectrum." The findings support the current medical recommendations for the use of ECT in adolescents. Possible explanations for the differences in diagnosis between the two age groups are discussed.
    Journal of the American Academy of Child & Adolescent Psychiatry 12/2001; 40(11):1332-6. DOI:10.1097/00004583-200111000-00014 · 7.26 Impact Factor
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