ECT plus Antidepressants: a Review

 Out on PubMed, from authors in Ohio, is this case series:

Pharmacologic management of adolescent catatonia: A dual-case series.

Leiby L, Shiplett L, Lin W, Dick M, Thornton H.Ment Health Clin. 2024 Jun 3;14(3):215-219. doi: 10.9740/mhc.2024.06.215. eCollection 2024 Jun.PMID: 38835818

The abstract is copied below:

Introduction: Catatonia is a syndrome characterized by psychomotor and behavioral disturbances and is associated with a substantially increased mortality risk in adolescent patients. There is a dearth of published literature describing treatment strategies for pediatric patients with catatonia. This dual-case series will describe the treatment course of 2 adolescent patients with catatonia at our pediatric inpatient psychiatric facility.

Case series: This case series presents 2 adolescent patients (a 17-year-old male and a 16-year-old female) who initially presented with worsening agitation and paranoia, later developing catatonia. Both patients required long durations of hospitalization and were treated with high-dose lorazepam before requiring the addition of electroconvulsive therapy (ECT).

Discussion: Treatment of pediatric patients with catatonia creates a significant burden on patients, families, and the healthcare system. Treatment with high-dose benzodiazepines is high risk, while ECT is both difficult to access and comes with its own risks. Both patients discussed are transitional age, meaning they will soon be young adults who will continue to require high-level psychiatric care. Psychiatric pharmacists have a large role to play in ensuring safe medication management for these complex patients.

Conclusions: This case series of 2 adolescent patients with catatonia demonstrates marginal reduction in symptoms with high-dose lorazepam in conjunction with ECT, with minimal side effects. This case series adds to the limited available literature regarding treatment of catatonia in pediatric patients and highlights the need for further study into effective treatment alternatives.

Keywords: ECT; benzodiazepine; catatonia; child and adolescent psychiatry; lorazepam; pediatrics.

The report is here.

And from the text:

Here is a report with two cases of adolescents with mood disorders and catatonic symptoms, written by pharmacists. There appears to be a typo in the abstract, as the patients are reported to have done very well with ECT.

The cases are complicated by the concurrent use of antipsychotic medications.

The literature on pediatric catatonia is still small, so kudos to these authors for their contribution.