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Teens Given Electroshock Treatment Showed Few Bad Effects


Cohen says fears about the use of ECT in youth "are not justified" and that some misunderstanding of the procedure comes from a lack of recognition of the severity of patients' illnesses. When it is used appropriately, the benefits are enormous, Cohen says. "When ECT works it is unbelievable; it is like a miracle. Most of them, they were like zombies before the treatment. Usually what they can do after the ECT is what they could do before they became ill."

He adds that in France, there are no restrictions on who can receive the treatments, in contrast to the U.S. Several states forbid the use of ECT for people under age 18.

"This is a problem, because I know of some extreme cases where patients should have had ECT and could not," Cohen says.

Several psychiatrists who reviewed the study for WebMD said it was instructive and well done. The study indicates that most of the time, the most effective treatment for the most severe form of depression is safe and does not cause brain damage, according to Alec Bodkin, MD, an assistant professor of psychiatry at Harvard School of Medicine. "It is important to be sure that the intuitively obvious thing is the case, which is that this is at least as safe in adolescents as in adults." Bodkin is also affiliated with McLean Hospital in Belmont, Mass.

Bodkin notes that the small study size indicates that in France, as well as in the U.S., ECT is underutilized in teens as well as adults. "ECT should be used more readily than it is. It works much more quickly and often more effectively than medications," says Bodkin. He adds that the procedure can be especially beneficial to teens, who often do not take their medications.

"I have had inpatients who were fiercely, fiercely ill, who were less than 20 years old, for whom ECT was necessary and who were helped by it," says Bodkin. "You cannot parent someone out of the need for ECT."

"This is the first good study that shows ECT in adolescents does not cause long-term memory problems," says Martin Szuba, MD, assistant professor of psychiatry at the University of Pennsylvania and director of the ECT program for the university's health system.

"ECT is grossly underutilized in adolescents," Szuba says. "Whether we like it or not, adolescents do develop severe depression and they do kill themselves, and there should be another treatment to offer them" beyond medications. "ECT can save lives."

Another physician had a more tepid response to the study. "They say that two out of 10 had [memory] complaints. ... That's about what you would expect in adults," says Mitchell S. Nobler, an assistant professor of clinical psychiatry at Columbia University College of Physicians and Surgeons. "They are trying to say that it is safe because they did not find impairment [of their memories and thinking]."

But Nobler says that he would have preferred testing aimed at their recall prior to the ECT, which is more commonly impaired after ECT. He also feels that the researchers relied on the adolescents' recollection, which is not always reliable.

Cohen does make an important point, however. "In the article, we did not include the school evaluation we did, because of space, but the ECT and non-ECT groups had the same school evaluations. So they were able to continue their educations [after the treatment]."

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