Pediatric ECT

The role of ECT in the treatment of adolescents and children is not well understood. The experience is limited and poorly documented, especially in pre-pubescent children. For much of the twentieth century, child and adolescent psychiatrists believed that the mental disorders of children and adolescents are psychologically, not biologically, determined. Psychological attitudes and family interactions were considered the cause of the pathology of the disorders. In the past two decades interest has shifted to biological causes and treatments. Depression and mania, autism, anorexia nervosa, and attention deficit hyperactivity disorder (ADHD) are now recognized in children and adolescents with increasing frequency. These shifts in attitude encourage greater interest in medication trials, and with these, increasing tolerance for trials with ECT. The renewed interest in the role of ECT in pediatric patients was shown at a 1994 conference when experts reported an additional 62 case reports beyond the 94 that had been described in publications. Patients between 14 and 20 years of age with major depressive syndromes, delirious mania, catatonia, or acute delusional psychoses had been successfully treated with ECT, usually after other treatments had failed. No reports of harm to age-related faculties, such as impaired maturation, growth, and the capacity to learn, were presented. On the contrary, the resolution of their mental disorders encouraged the young people to complete school and continue their education. No adjustments to the adult ECT protocol were required except that close attention was given to energy dosing. Adolescents require very little energy to induce an effective seizure. No reporter described instances of uncontrolled seizures. Some clinicians, faced with seriously ill adolescents with features that would encourage ECT if the features were seen in adults, now recommend ECT. Examples of the successful treatment of melancholia, psychosis, mania, and catatonia dot the literature. Efficacy is reported in patients with severe mental retardation and in those with self-injurious repetitive behavior and catatonia grafted onto various forms of autism. These reports are sufficiently encouraging to loosen the usual injunctions against the use of ECT in adolescents. In 2004, the American Academy of Child and Adolescent Psychiatry offered official practice guidelines for the use of ECT in adolescents that closely follow the guidelines for treatment in adults.