Lincoln Medical and Mental Health Center, New York, NY, USA.
Icahn School of Medicine at Mount Sinai, Babcock Building, 5 West, 1111 Amsterdam Avenue, New York, NY, 10025, USA.
Eur Child Adolesc Psychiatry. 2023 Sep;32(9):1529-1560. doi: 10.1007/s00787-022-01942-7. Epub 2022 Jan 9.
Electroconvulsive therapy (ECT) is a well-established treatment for adults with mood disorders. However, its use in child and adolescent populations is less common. At the same time, approximately 60% of child and adolescent patients do not respond satisfactorily to first-line treatments for mood disorders. Given the need for effective treatments for severe mood disorders in adolescents and the low use rate of ECT, this systematic review examines the existing literature on the effectiveness and adverse effect profile of ECT when used for treatment-resistant mood disorders in children and adolescents. Searches were conducted in Medline, Embase, and PsycInfo using search terms related to (1) children and adolescents, (2) mood disorders, and (3) ECT. Searches identified 1715 unique articles. The full text of 71 selected articles were reviewed, leading to 41 studies included in the study. A standardized data extraction tool was used to collect key information from each study (i.e. author and publication year, objectives, participants and setting, design, measures, clinical outcomes, and side effects). As most of the studies found were case series, the Joanna Briggs Institute Case Series Critical Appraisal tool was used to assess quality. Studies were summarized qualitatively by comparing findings across key study parameters. Our review identified 41 studies for inclusion. Twenty were case series, two were case-control studies, and nineteen were case reports. Overall treatment response rates ranged from 51 to 92%, with patients receiving an average of 12 treatments. Among studies with n > 30, response rates were largely 70-82% for depression and 87-90% for mania. Seven studies used the Mini-Mental State Exam and found no evidence of significant post-treatment cognitive impairment. The majority of side effects were minor and transient. Tardive seizure was reported in 4 (0.6%) patients. ECT was discontinued early due to side effects in 11 (1.5%) cases. No fatalities were reported. Our data suggest that ECT is safe and effective for the treatment of mood disorders in child and adolescent populations, and should be considered in severe and treatment-refractory cases. Controlled studies with objective measures and long-term follow-up are needed to advance the evidence base.
电抽搐治疗（ECT）是一种成熟的成人情绪障碍治疗方法。然而，在儿童和青少年人群中的使用较少。与此同时，约 60%的儿童和青少年患者对情绪障碍的一线治疗反应不佳。鉴于青少年严重情绪障碍需要有效的治疗方法，以及 ECT 的低使用率，本系统评价检查了 ECT 治疗儿童和青少年难治性情绪障碍的现有文献，以评估其有效性和不良反应概况。使用与（1）儿童和青少年、（2）情绪障碍和（3）ECT 相关的搜索词在 Medline、Embase 和 PsycInfo 中进行了搜索。搜索共确定了 1715 篇独特的文章。回顾了 71 篇选定文章的全文，最终纳入了 41 项研究。使用标准化的数据提取工具从每项研究中收集关键信息（即作者和出版年份、目标、参与者和设置、设计、措施、临床结果和副作用）。由于大多数研究都是病例系列研究，因此使用 Joanna Briggs 研究所病例系列关键评估工具评估了质量。通过比较关键研究参数的发现，对研究进行了定性总结。我们的综述共纳入了 41 项研究。其中 20 项为病例系列研究，2 项为病例对照研究，19 项为病例报告。总体治疗反应率从 51%到 92%不等，患者平均接受了 12 次治疗。在 n>30 的研究中，抑郁的反应率主要为 70-82%，躁狂的反应率为 87-90%。7 项研究使用了 Mini-Mental State 考试，没有发现治疗后认知功能显著受损的证据。大多数副作用轻微且短暂。4 例（0.6%）患者报告出现迟发性癫痫。由于副作用，11 例（1.5%）患者提前停止治疗。没有死亡报告。我们的数据表明，ECT 治疗儿童和青少年情绪障碍是安全有效的，对于严重和治疗抵抗的病例应考虑使用。需要进行具有客观措施和长期随访的对照研究，以推进证据基础。
