Electroconvulsive Therapy in Adolescents with Treatment-Resistant Catatonia and Severe Mood Disorders: A Systematic Review of Efficacy and Cognitive Outcomes

Abstract

Introduction: Electroconvulsive therapy (ECT) is used sparingly in adolescents despite evidence of efficacy in adult treatment-resistant conditions. Catatonia and severe, life-threatening mood disorders in youth may respond to ECT when pharmacotherapy fails, yet concerns about cognitive side effects limit utilization. This review synthesizes outcomes of ECT in adolescents.

Methods: We searched PubMed, PsycINFO, and Embase for case series, cohort studies, and controlled trials (any design, n≥5) of ECT in adolescents (10–19 years) with catatonia, bipolar mania, or major depressive disorder with psychosis or suicidality. Primary outcomes: clinical response (≥50% symptom reduction on Clinical Global Impression–Severity scale or catatonia rating scale) and cognitive function (processing speed, verbal memory). Random-effects meta-analysis for response rates.

Results: Seventeen studies (n=312 adolescents; mean age 15.8 years; 58% female) met inclusion: 1 prospective cohort, 16 retrospective case series. Pooled response rate was 78% (95% CI 71–85%). Catatonia had highest response (92%), followed by psychotic depression (81%), then manic episodes (68%). Mean number of ECT sessions was 9.2 (range 6–18). Cognitive outcomes: transient retrograde amnesia (1–4 weeks post-ECT) occurred in 54% of patients; processing speed returned to baseline by 2 months in 92%. Persistent memory deficits (>6 months) were rare (3%). Mortality: none. Relapse rate at 6 months was 34% in responders who did not receive maintenance ECT.

Discussion: ECT is highly effective for adolescent catatonia and severe mood disorders, with cognitive side effects largely transient. The 34% relapse rate suggests maintenance ECT should be considered. Limitations include absence of randomized sham-controlled trials and lack of standardized cognitive batteries.

Conclusions: Electroconvulsive therapy is safe and efficacious for life-threatening or treatment-resistant adolescent catatonia and severe mood disorders. Cognitive risks are mostly short-term. Referral to specialized ECT youth services is recommended.