Among adolescents and young adults being treated for major depression with electroconvulsive therapy (ECT), a lower probability of treatment response and remission, as well as a greater number of ECT treatments, was found in female patients with a history of nonsuicidal self-injury (NSSI) than in patients without NSSI, according to a study published in the Journal of Affective Disorders.
Investigators examined medical records of 48 patients who had been treated with ECT at the Johns Hopkins Hospital between 2007 and 2014. Patients were between the ages of 14 and 25 years, and 50% were female. There were 16 patients (33%) with NSSI, 14 (88%) of whom were female. Among patients without NSSI, 10 (32%) were female.
Investigators collected demographic and clinical information including data on ECT to determine whether a history of NSSI was associated with ECT responsiveness in adolescents and young adults.
In initial analyses, the presence of NSSI was not associated with ECT outcomes, but in subgroup analyses, the presence of NSSI was associated with lower odds of response (odds ratio, 0.04; 95% CI, 0.0004-0.81; P =.03) and remission (odds ratio, 0.09; 95% CI, 0.0000-0.81; P =.03), as well as 5.83 more ECT treatments (95% CI, 0.27-11.39; P =.04) among adolescent and young adult female patients compared with patients without NSSI.
The overall ECT treatment response rate among patients with NSSI was 58%, which is lower than typical response rates in the general adult population (60%-80%).2 The response rate among patients without NSSI was 66%. The remission rate for patients with NSSI was 38% compared with 47% of patients without NSSI. In addition, the average number of ECT treatments in the cohort was 12.6 sessions compared with typical acute courses of ECT, which are 6 to 12 treatments.
Study limitations include small sample size and no control group to compare depressive symptoms in patients not receiving ECT. Previous medication trials, level of treatment resistance, or other data that might predict ECT efficacy were also not included. Future studies could examine how NSSI affects ECT efficacy in adults.
The researchers wrote, “ECT overall may not be as efficacious in the adolescent and young adult population as it is in the general adult population.”
“[O]ur data suggest caution when considering an adolescent or young adult woman for a course of ECT,” they concluded.
1. Rootes-Murdy K, Carlucci M, Tibbs M, et al. Non-suicidal self-injury and electroconvulsive therapy: outcomes in adolescent and young adult populations. J Affect Disord. 2019;250:94-98.
2. Weiner RD. Introduction to convulsive therapy. In: Brain Stimulation: Methodologies and Interventions. Reti IM, ed. Blackwell, NJ: Wiley; 2015.