Effects of Electroconvulsive Therapy in Adolescents with Severe Endogenous Depression Resistant to Pharmacotherapy Michael Strober, Uma Rao, Mark DeAntonio, Edward Liston, Matthew State, Lisa Amaya-Jackson, and Sara Latz Background: This open, prospective study examined the effects of electroconvulsive therapy (ECT) in 10 adoles- cents with primary, endogenous, psychotic depression who were resistant to antidepressant pharmacotherapy. Methods: Change in symptom severity from baseline was assessed weekly with Hamilton Depression Rating Scale (HDRS) ratings, and outcome was measured additionally at 1 month, and again at 1 year, post-ECT. Results: All but 1 patient demonstrated dramatic improve- ment, with statistically significant decreases in mean HDRS score detected after the first week of treatment. All responders maintained the benefits of their treatment. Conclusions: The results provide evidence of the clinical effectiveness of ECT in adolescents with phenomenologi- cal characteristics shown to be predictive of ECT response in adults. Biol Psychiatry 1998;43:335–338 © 1998 So- ciety of Biological Psychiatry Key Words: Electroconvulsive therapy, adolescents, en- dogenous, delusional, antidepressants, refractory Introduction D espite impressive advances in the pharmacotherapy of depressive illness over the years, the responsive- ness of certain subtypes to drug therapy, delusional in particular, is much less compelling. Many such patients do respond dramatically to electroconvulsive therapy (ECT) (Fink 1989; Abrams 1992), although prior failure to respond to antidepressant drugs may forecast a less bene- ficial acute response to ECT, as well as increased risk of subsequent relapse (Prudic et al 1990). Whether or not antidepressant drugs improve the long- term outcome of depressive illness in adolescents is a question still unresolved (Jensen et al 1992); however, the protracted course, morbidity, and recurrence of major depression in this age group is increasingly well docu- mented (Harrington and Vostanis 1995). Given recent evidence (Coryell et al 1994) that the delusional subtype of depression has robust diagnostic stability across recur- rences of illness, demonstration of the potential benefits of ECT in youth with severe depression is of considerable importance. Several recent, mainly retrospective, accounts (Bertagnolli and Borchardt 1990; Schneekloth et al 1993; Kutcher and Robertson 1995; Moise and Petrides 1996) describe beneficial effects of ECT in diagnostically heter- ogeneous groups of adolescents. The present report, from a prospective longitudinal study of adolescent major de- pression, details the acute response to ECT in 10 patients who were initially resistant to pharmacotherapy, and their outcome at 1 year posttreatment. Methods and Materials Patients The sample consists of all 10 patients admitted to the adolescent service of the UCLA Neuropsychiatric Institute and Hospital between January 1978 and August 31, 1996 who received ECT as part of their inpatient treatment. In this respect, they represent a subset of patients treated by this service for whom ECT was recommended, but declined by either family or patient. All patients met criteria for primary major depression at the definite level of certainty based on the judgment of two faculty clinicians using Research Diagnostic Criteria (RDC; Spitzer et al 1978), and later affirmed by three additional faculty who evaluated these patients as part of a hospital-mandated pre-ECT certifica- tion process for minors. Each patient also fulfilled RDC for endogenous, psychotic, and incapacitating subtype of major depression. Three patients had prior episodes of either mania or hypomania, and 3 of the 7 nonbipolars had prior episodes of either minor or major depression. Each patient expressed suicidal ideation continuously up to the start of ECT, and 4 engaged in some form of deliberate self-harm in hospital prior to ECT, From the Department of Psychiatry & Biobehavioral Sciences, Neuropsychiatric Institute & Hospital, School of Medicine, University of California at Los Angeles, Los Angeles, California (MS, UR, MD, EL, MS, SL); and Department of Psychiatry, Duke University Medical Center, Durham, North Carolina (LAJ). Address reprint requests to Michael Strober, PhD, UCLA Neuropsychiatric Insti- tute, 760 Westwood Plaza, Los Angeles, CA 90024-1759. Received October 11, 1996; revised February 21, 1997; accepted February 26, 1997. © 1998 Society of Biological Psychiatry 0006-3223/98/$19.00 PII S0006-3223(97)00205-9