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April 27th, 2011
08:45 AM ET

Is electroconvulsive therapy safe?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Ky-Nisha of Florida:

Is electroconvulsive therapy safe to use on children?

Expert answer:

Electroconvulsive therapy, or ECT, is a funny business. By far the most effective treatment in psychiatry, it is also by far the most reviled.

At least as safe as many of our medications, its use is nonetheless severely circumscribed in many states. It's an intervention with generally mild side effects, but many people emotionally equate it with lobotomy, aided in this regard by searing images from the classic film "One Flew Over the Cuckoo's Nest."

On the other hand, those of us who have seen countless patients saved from suicide or natural death from their severe psychiatric conditions have a profound admiration for the procedure.

It appears that children and adolescents are no less likely to benefit from ECT than are adults, and so the quick answer to your question is: Yes, ECT is safe in children and adolescents.

FDA panel deems electroshock devices high risk

In fact, guidelines for its use in these patients were published by the American Academy of Child and Adolescent Psychiatry in 2004. The essence of these guidelines is that ECT should be considered in children with severe psychiatric disorders and/or in cases of significant suicide risk when other interventions have failed.

To understand these guidelines, we have to keep two somewhat opposite truths in mind. The first truth is that most children and adolescents with psychiatric struggles can be helped immensely by psychotherapeutic or pharmacological interventions, not only for themselves but for their parents.

For example, a large recent study showed that resolving a mother's depression had a bigger positive effect on the mental health of her children than it had on her.

The second truth is that, although rare, cases of severe mood and psychotic disorders in young people are not unknown. These cases can be catastrophic, as anyone who has worked on an inpatient child/adolescent psychiatric unit can attest. When young people with these conditions have failed other interventions, ECT can be a lifesaver.

By the way, I'm not using the word "lifesaver" in a metaphoric sense. Before the age of modern medications, approximately 5% of patients admitted to psychiatric hospitals died from their symptoms.

Today, we rarely see a condition called malignant catatonia, but it used to be far more common, and it used to kill almost everyone who developed it.

Death usually came from extremely high body temperatures (up to 110 degrees Fahrenheit) or from the development of a pulmonary embolus or sudden cardiac death.


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