Abstract
This study evaluates the apparent effectiveness and acute tolerability of electroconvulsive therapy (ECT) in adolescents and young adults with treatment-resistant acute bipolar episodes. Twenty-two rigorously evaluated and diagnosed adolescents were studied: 11 with acute mania and 11 with an acute depressive state. ECT treatment was agreed to by 16 of the patients and refused by 6 who elected to continue with standard pharmacologic inhospital care. The 16 ECT-treated patients underwent a total of 166 individual ECT treatments, given using the brief pulse method at a dose of two treatments per week. Treatment outcome in the ECT-treated group was significantly better than in the ECT-refusing group (p < 0.03). ECT treatment was associated with acute effects in 27% of the sample. Side effects were generally mild and mostly consisted of headaches. The mean length of hospital stay in the ECT-treated group was less than half that of the group who opted for continued pharmacotherapy (73.8 days compared to 176 days), and the cost per hospitalization in the ECT-treated group averaged about 60% less than for the ECT-refusing group ($58,608.00 compared to $143,264.00, Canadian dollars). These findings suggest that ECT may be a useful and cost-effective treatment for severe acute manic and psychotic depressive states in bipolar adolescents.
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