Electroconvulsive Therapy and Transcranial Magnetic Stimulation: Can They be Considered Valid Modalities in the Treatment of Pediatric Mood Disorders?

Depression in children and adolescents is a severe and debilitating disorder. It can be life endangering, but even when not, it has a grave impact on the quality of life of youngsters and their families and interferes with normal growth and development. In recent years, the field of child psychiatry has become more aware of the limited applicability of data from the adult literature to children and adolescents and the limited resources that child psychiatrists have in treating depression. In our opinion, this awareness substantiates the need to define the place of ECT and TMS in the treatment of pediatric depression. As portrayed in this article, there is a considerable knowledge about ECT in adolescents (although much less in children). Side effects do exist and should be studied more thoroughly. Our data support the notion that ECT is an effective therapy for severe and resistant depression, with relatively minimal adverse effects. The place of ECT in pediatric bipolar disorder is not well established. From the hundreds of cases published in many countries throughout the globe, no evidence substantiates the fear of significant damage to the developing brain. Current evidence suggests that ECT-related memory impairment is transient, with no adverse consequences to future cognitive functioning. These contentions are only preliminary, however, because there is a paucity of systematic research of post-ECT cognitive functioning. TMS is a more novel treatment modality. Despite the lack of well-designed RCTs in depressed minors, TMS has been performed in children and adolescents for other indications with favorable results and minimal adverse effects. Our literature review suggests that TMS has been administered to prepubertal children to a considerably greater extent than ECT, perhaps building itself as a valid therapeutic procedure for this age group. TMS is apparently less effective than ECT, so its place in the treatment of severe, persistent, and psychotic depression or life-endangering conditions (eg, catatonia and severe suicidality) is questionable. On the other hand, it seems likely that because of its high safety profile and acceptability by patients, TMS will be considered an earlier therapeutic option for the treatment of child and adolescent depression. Future research calls for the establishment of multi-site, multinational RCTs to establish the place of ECT and TMS in the treatment logarithm of child and adolescent mood disorders.