FFFElectroconvulsive Therapy (ECT)

No. 138; June 2022

Electroconvulsive therapy (ECT) is not a common treatment for children and adolescents. It may be considered for conditions such as depression, bipolar disorder, psychosis, catatonia, neuroleptic malignant syndrome, and self-injurious behaviors when medications and other treatments have not worked or when the condition is severe.

What is ECT and how does it work?

While ECT can be done in the outpatient setting, many treatment centers will start ECT with your child admitted to the hospital. During ECT, the brain is electrically stimulated to cause a seizure under anesthesia while the patient is being closely monitored. The seizure usually lasts between 20 seconds to just over a minute. The length of the entire procedure, from going to sleep until waking up, is about 5-10 minutes. Usually, the patient is observed for 30 minutes or longer following the procedure

The exact way ECT works is not fully known, but when a seizure occurs, many hormones and chemicals are released in the brain. ECT can help many patients improve quickly.

Why is the doctor recommending ECT?

ECT has been found to be effective for the following conditions:

  • Depression that has failed to respond to multiple medications and psychotherapy
  • Severe depression in patients who are not eating, not drinking, or are having intense self-harm behaviors
  • Bipolar disorder (mania, depression or a mixed state)
  • Psychotic disorders
  • Catatonia which is a potentially life-threatening condition
  • Neuroleptic malignant syndrome which is a life-threatening condition that may be caused by certain medications

Is ECT safe?

ECT has been shown to be safe, even in pregnant women and the elderly. The risks are similar to the risks associated with getting general anesthesia. While there are no absolute medical reasons why someone should not get ECT, some conditions need more evaluation and monitoring, such as diabetes, heart problems, pneumonia, brain tumors or a history of seizure disorder.

Your child will have a complete medical evaluation before the start of ECT, and the treatment team will often give medications to prevent common side effects like headaches, muscle pain, nausea, and vomiting. Other side effects include memory loss and trouble learning new things, which typically improve over time.

How long is a course of treatment of ECT?

The length of an ECT course will be decided by the treatment team, though the average is 12-16 treatments over 4-6 weeks. Treatments typically start three times per week and then decrease in frequency based on the response and the condition being treated.

Most patients start feeling better within the first few weeks. More severe conditions may take longer to respond. Some children may need further treatments known as maintenance ECT to try and stop the return of their symptoms.

Things to keep in mind:

  • Laws about ECT for children and adolescents vary by state. Some states have no regulations and others have very strict requirements around age limits, who can provide informed consent, and who can provide ECT treatment.
  • Most insurance companies cover ECT. Your treatment team will work with you to determine coverage.
  • It is recommended that your child continues seeing a child and adolescent psychiatrist after the course of ECT is completed. This is to help monitor symptoms, prescribe medications, provide psychotherapy, and watch for recurrence. .

 

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