ECT in Patients Aged 16-30: Data From the Harvard Group

 Out on PubMed, from the Harvard group, is this paper:

The Efficacy and Cognitive Effects of Acute Course Electroconvulsive Therapy Are Equal in Adolescents, Transitional Age Youth, and Young Adults.

Luccarelli J, McCoy TH, Uchida M, Green A, Seiner SJ, Henry ME.J Child Adolesc Psychopharmacol. 2021 Oct 6. doi: 10.1089/cap.2021.0064. Online ahead of print.PMID: 34619038

The abstract is copied below:
Objective: Electroconvulsive therapy (ECT) is the most effective acute treatment for depression, but its use in younger patients is rare and heavily regulated in many U.S. states. It is unclear whether age modifies treatment response or tolerability in adolescents, transitional age youth, and young adults. We examined the effects of ECT on depression and cognition in patients aged 16-30 years. Methods: A retrospective cohort study of patients aged 16-30 years receiving ECT between 2011 and 2020 who were evaluated with the Quick Inventory of Depressive Symptomatology (QIDS), the Behavior and Symptom Identification Scale-24 (BASIS-24), and the Montreal Cognitive Assessment (MoCA) at baseline and following treatment #10. Results: Among the 424 patients who met the inclusion criteria, ECT was associated with a decrease in depression symptoms (ΔQIDS -6.7; Kruskal-Wallis rank sum test; χ2 = 293.37; df = 2; p < 0.0001) and improvement in overall self-reported mental health status (ΔBASIS-24 - 0.70; Kruskal-Wallis rank sum test; χ2 = 258.5; df = 2; p < 0.0001) during the first 10 treatments, with a slight reduction in cognition as measured by the MoCA (ΔMoCA -1.1; Kruskal-Wallis rank sum test; χ2 = 33.7; df = 1; p < 0.0001). Age was not a significant predictor of QIDS, BASIS-24, or MoCA changes. Conclusions: Among 424 patients aged 16-30 years receiving acute course ECT, age was not a significant predictor of improvement in depression, change in overall self-reported mental health status, or change in cognition. These results support the utility of ECT in the treatment of adolescents and young adults.

Keywords: adolescent psychiatry; cohort studies; depressive disorders; electroconvulsive therapy.



Here we have yet another interesting and important dataset from the Harvard group, this one demonstrating the efficacy and tolerability of ECT in a very large cohort of adolescents and young adults. No surprises here, but it is very helpful to have these results in the published evidence base. Since 96% of the sample had RUL-UBP ECT, we might expect even better efficacy results with more powerful forms of ECT. 
The point made by the authors, that restrictive regulations of ECT in children and adolescents are not clinically rational, is well taken.
Kudos to Dr. Luccarelli and colleagues for this valuable contribution to the ECT literature.

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