ELECTROCONVULSIVE TREATMENT IN ADOLESCENTS WITH PHARMACOTHERAPY-REFRACTORY DEPRESSION

The effectiveness and safety of ECT in pharmacotherapy-refractory depr ession 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 anti depressant pharmacotherapy. After a thorough diagnostic evaluation, pa tients received a course of ECT involving 11.2 +/- 2.0 (range 8-15) ad ministrations. ECT was commenced with bilateral treatment in 2 adolesc ents and nondominant right electrode placement in 9 patients; 5 of the 9 patients were subsequently changed to bilateral treatment. All 11 p atients improved to a clinically significant degree. Significant impro vements were noted in scores on the Children Depression Rating Scale-R evised (CDSR-R) and the Global Assessment of Functioning Scale (GAF) ( p < 0.05). Euthymia, defined as CDRS-R score less than or equal to 40, was achieved by 64% (7/11) of patients. The Mini-Mental State Examina tion showed no significant decline in cognitive functioning. Neuropsyc hological testing completed in 5 subjects both before ECT and 1-5 days after the last treatment, indicated a significant decline in attentio n, concentration, and long-term memory search. Minor side effects, exp erienced within the first 12 hours of treatment, were headache (80% of patients) and nausea/vomiting (64%). The potentially serious complica tion of tardive seizure (after full recovery of consciousness) occurre d in 1 adolescent. Prolonged seizures (> 2.5 minutes) were noted in 7 of the 11 patients (9.6% of the 135 ECT administrations). Pending furt her research on ECT in youth, it is recommended that ECT should only b e administered to youth in hospital settings, that all regularly admin istered psychotropic medications (including antidepressants) be discon tinued before ECT and restarted after the final administration of ECT, and that physicians be aware that 12 treatments are usually sufficien t, but that 15 treatments may occasionally be necessary for treating d epressed adolescents. With the understanding that scientific evaluatio n of ECT in youth is lacking, it appears that ECT can be an effective and relatively safe treatment for depressed adolescents who have faile d to respond to antidepressant pharmacotherapy.