Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depressive and psychotic illnesses. It uses a brief electrical impulse lasting a few seconds to trigger a brief neuronal overexcitation in the brain. This is not noticeable to the patients because the treatment is carried out using a short anesthesia. ECT releases various neurotransmitters in the brain and stimulates the growth of nerve cells in certain areas of the brain. In adults, this form of therapy is often used to treat severe mental illnesses, such as treatment-resistant depression or schizophrenia. In children and adolescents, on the other hand, it is used much less frequently. This could be due to the fact that, in contrast to adults, there are no large studies on the safety and effectiveness of this treatment method in children and adolescents. In addition, there is a lack of knowledge about electroconvulsive therapy among medical professionals treating children and adolescents.
Over 40 percent respond to ECT treatment
To help close this knowledge gap, researchers from the Central Institute of Mental Health (CIMH) in Mannheim, the University Medical Centre Göttingen and the University Medical Centre Rostock report in the Journal of ECT on a total of 32 children and adolescents who were treated with electroconvulsive therapy at the three clinics. All of the children had severe mental illnesses and they failed to respond to other forms of therapy such as medication and psychotherapy.
Despite this difficult initial situation, 40.6 percent of the children and adolescents responded to the treatment and 21.9 percent were even symptom-free or almost symptom-free after the treatment. There were no severe side effects and 65.6 percent of the children and adolescents had no side effects at all.
More large controlled trials needed
“Our data underline that electroconvulsive therapy is also very safe and effective in children and adolescents,” says Dr Sebastian Karl, a doctor at the Department of Psychiatry and Psychotherapy at the Central Institute of Mental Health (CIMH) and one of the authors of the study. “Nevertheless, we urgently need large controlled studies that systematically examine ECT in children and adolescents.”
When analysing the data, the researchers also noticed that the response to electroconvulsive therapy was related to how many other treatments the patients had received beforehand. “This suggests that severely mentally ill children and adolescents could benefit from being offered ECT earlier in the treatment process,” says Prof. Dr. Alexander Sartorius, senior physician and head of the Translational Imaging research group at the CIMH.
“It would be desirable if more centres than the three clinics mentioned in Germany offered ECT as a treatment option for adolescents with severe depressive and psychotic disorders. There are often very long waiting times for ECT and hardly reasonable travel distances for parents and their seriously ill children,” adds Dr Boris Rothermel, doctor at the Department of Child and Adolescent Psychiatry and Psychotherapy at the CIMH.
Publication:
Karl S, Methfessel I, Weirich S, Rothermel B, Crozier J, Besse M, Reinhardt M, Buchmann J, Dück A, Schulz J, Zilles-Wegner D, Häßler F, Kölch M, Uebel von Sandersleben H, Poustka L, Sartorius A. Electroconvulsive Therapy in Children and Adolescents in Germany-A Case Series From 3 University Hospitals. J ECT. 2022 Jun 11. doi: 10.1097/YCT.00000000000861. epub ahead of print. PMID: 35700967.