A retrospective case series of electroconvulsive therapy in the management of depression and suicidal symptoms in adolescents

Objective Major depressive disorder (MDD) with suicidal symptoms is common in adolescents. Electroconvulsive therapy (ECT) is highly effective in the treatment of MDD. We have described its use and outcome in a case series of adolescents with depression and suicidal symptoms receiving ECT. Methods We analyzed 362 adolescents aged from 12 to 17 who had received ECT between year 2015 and 2021. A total of 278 subjects were found to meet the inclusion criteria, where depressive symptoms were assessed by HDRS and suicidal symptoms were assessed by HDRS item 3. Their sociodemographic, clinical, and treatment information were retrieved through these records for this study. Results The mean +/- SD age of subjects was 15.41 +/- 1.50 years and male sex was 14.7% (n = 41). Comorbid diagnoses were present in 104 patients (37.4%). The ECT sessions ranged from 6 to 12 times. All the patients took antidepressants, with sertraline (n = 182; 65.5%) being the most widely used. Majority of patients also received benzodiazepines. ECT was significantly effective in adolescents with depression and suicidal symptoms in evaluation by HDRS, HDRS item 3, CGI-S (p < .001) pre/post-ECT. The response rate of MDD patients was 52%, with suicidal ideation (SI) at 49%, and 54% in MDD with suicide attempt (SA). The change of CGI-S scores showed no significant differences between various subgroups of sex and comorbid (p>.05), but there were significant differences between subgroups of suicidal symptoms (p < .001). ECT was generally safe with subjective memory complaint (n = 189, 68.0%), headache (n = 150, 54.0%), body pain (n = 28, 10.1%), delirium (n = 95, 34.2%), and nausea (n = 31, 11.2%) as possible side effects following ECT. Conclusion In this study, ECT was found to decrease depressive and suicidal symptoms in adolescents, and the side effect was acceptable. ECT showed better outcome for MDD with SA compared to MDD with SI.