Electroconvulsive therapy in children and adolescents

Electroconvulsive therapy (ECT) is a recognized and effective treatment in adults for several psychiatric and neurological conditions in which the use of pharmacotherapy is ineffective, untimely or contraindicated. It has been used with success in mood and psychotic disorders, catatonia, neuroleptic malignant syndrome, Parkinson's disease and intractable seizures. Its benefits have been recognized and its risks identified through an extensive body of research. The benefits of ECT are not limited to the adult population; research has been conducted on its use in child and adolescent populations for decades. In 2004, the American Academy of Child and Adolescent Psychiatry published practice parameters for the use of ECT in adolescent populations. However, ECT continues to be underused in cases where it is clearly indicated. In this article, we review the use of ECT in the adolescent population; its indications, administration, contraindications and risks, with emphasis on articles published after the American Academy of Child and Adolescent Psychiatry practice parameters were formulated. We also review reasons behind the underutilization of ECT in adolescents for whom this treatment modality is indicated.