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
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]."