Over the last decade we have seen a steady and alarming increase in the number of deaths by suicide in adolescents. At the present time, there is little data documenting the effectiveness of interventions for the management of self-harm behaviors and suicidal ideation (SI) in children and adolescents, with only a handful of studies supporting the efficacy of psychotherapeutic techniques in this context.
Previous studies have demonstrated the efficacy and tolerability of electroconvulsive therapy (ECT) for the treatment of depression in adolescents and young adults. Response to ECT in adolescents is similar to that observed in adults and indicates that ECT is highly effective for the treatment of depression in this population. Nonetheless, fewer than 1% of ECT treatments in the US are given to patients under the age of 18, and access to the procedure is legally restricted for adolescents in 21 states.
In a retrospective cohort study of adolescent patients who received ECT at Mass General Hospital, James Luccarelli, MD, DPhil and colleagues examined the impact of ECT on suicidal ideation. In this sample of 108 adolescents (64 female; 59.3%), 96 of whom reported baseline SI, the mean age was 18.1 ± 1.0 years, and diagnoses were major depressive disorder (86; 79.6%), bipolar disorder (13; 12.0%), and other (9; 8.3%).
ECT was associated with a significant reduction in self-reported SI over the course of 5 to 10 treatments. In this cohort, the proportion of individuals reporting SI decreased from 88.9% at baseline to 57.4% by the end of treatment. The number of participants reporting severe SI also decreased, from 29.6% at baseline to 12.0% at the end of treatment.
Improvements in SI during the course of ECT treatment were moderately correlated with overall changes in depressive symptoms as measured using the Quick Inventory of Depressive Symptoms (QIDS). What this means is that while in most individuals, reductions in SI paralleled improvements in depressive symptoms, some patients had improvement (or worsening) of suicidality without broader changes in depressive symptoms.
This study indicates that ECT treatment is associated with a reduction in suicidal ideation. This study was conducted in a single clinical setting, and future studies are needed to evaluate the efficacy of ECT in other settings. In addition, more research is needed to determine how acute treatment with ECT could be combined with pharmacologic and/or psychosocial interventions to further reduce risk for self-harm and suicidal behaviors in the population.
At a time when suicide rates are on the rise in children and adolescents, it is imperative that we focus on the development and study of interventions designed to reduce self-harm and suicidal behaviors in this vulnerable population. Restricting access to ECT in adolescents may be hampering access to a promising treatment for suicidal ideation in youth.
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Luccarelli J, McCoy TH Jr, Seiner SJ, Henry ME. Electroconvulsive therapy is associated with a reduction in self-reported suicidal ideation in adolescents. Brain Stimul. 2022 Aug 24;15(5):1181-1183.
Luccarelli J, McCoy TH, Uchida M, Green A, Seiner SJ, Henry ME. The Efficacy and Cognitive Effects of Acute Course Electroconvulsive Therapy Are Equal in Adolescents, Transitional Age Youth, and Young Adults. J Child Adolesc Psychopharmacol. 2021 Oct;31(8):538-544.
Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Interventions for self-harm in children and adolescents. Cochrane Database Syst Rev. 2021 Mar 7;3(3):CD013667. doi: 10.1002/14651858.CD013667.pub2.
