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Acute Phase Treatment Outcomes of Electroconvulsive Therapy in Adolescents and Young Adults

Benson, Nicole M. MD*,†; Seiner, Stephen J. MD*; Bolton, Paula MS, ANP-BC*; Fitzmaurice, Garrett ScD*; Meisner, Robert C. MD*,†; Pierce, Casey BA; Busch, Alisa B. MD, MS*,§

doi: 10.1097/YCT.0000000000000562
Original Studies

Objective Electroconvulsive therapy (ECT) is a highly efficacious, well-tolerated treatment in adults. Little is known, however, about its effectiveness in adolescents and young adults. Our objectives were to assess clinical outcomes after acute phase ECT in adolescents and young adults and determine whether screening positive or negative for a substance use disorder (SUD) is associated with differences in treatment outcomes.

Methods Study sample consisted of all patients 16 to 25 years old who received ECT from May 2011 to August 2016 and who completed self-reported SUD screens and the Behavior and Symptom Identification Scale-24 (BASIS-24) initially and completed the BASIS-24 again after the fifth ECT treatment. For 5 BASIS-24 domains, longitudinal changes in mean domain scores were assessed; mean changes by SUD screening status were also examined using linear mixed models.

Results One hundred ninety adolescents and young adults, with mean age 21.0 ± 2.6 years, met inclusion criteria. Electroconvulsive therapy was associated with significant clinical improvement (score decreases) in all 5 BASIS-24 domains during the acute phase treatment (P < 0.001). Sixty-four percent (122/190) screened positive for SUD. Compared with adolescents and young adults screening negative for SUD, those screening positive for co-occurring SUD had greater improvement in depression/functioning (−0.37 ± 0.14, P = 0.009), interpersonal relationships (−0.27 ± 0.13, P = 0.045), and emotional lability (−0.27 ± 0.14, P = 0.044) domains after the fifth ECT treatment.

Conclusions Electroconvulsive therapy in adolescents and young adults was associated with significantly improved clinical outcomes during acute phase treatment. Adolescents and young adults screening positive for SUD had better acute phase ECT outcomes in self-reported depression/functioning, interpersonal relationships, and emotional lability than those screening negative. More research is needed to clarify adolescents and young adult patient characteristics that may be associated with differential ECT outcomes.

From the *McLean Hospital, Belmont

Department of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, MA

Social & Scientific Systems, Inc, Durham, NC

§Department of Health Care Policy, Harvard Medical School, Boston, MA.

Received for publication April 18, 2018; accepted October 12, 2018.

Reprints: Nicole M. Benson, MD, Department of Child and Adolescent Psychiatry, Massachusetts General Hospital, 32 Fruit St, Yawkey 6A Boston, MA 02114 (e-mail:

Conflicts of interest and sources of funding: Funding support was provided by Massachusetts General Hospital/McLean Hospital Research Concentration Program NIMH R25MH094612 (N.M.B.) and the Health Services Research Division of Partners Psychiatry and Mental Health (A.B.B., G.F., C.P.). For the remaining authors, none were declared.

Online date: December 18, 2018

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