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Because of the limited number of case reports on the use of electroconvulsive therapy (ECT) in adolescent psychiatric patients, we retrospectively reviewed the medical records of 20 young patients who underwent ECT. They constituted all the patients ≤ 18 years of age who had received ECT at our institution from 1983 through 1991. We also reviewed the literature. In our series of adolescents, ECT reduced or eliminated symptoms in patients with bipolar disorder, major depression, and schizophreniform disorder. It was less effective in patients with schizophrenia and schizoaffective disorder and produced no response in those with personality disorders. Treatments elicited no recorded adverse effects, even in patients with concomitant systemic problems, including a seizure disorder, a renal transplant, and a septum pellucidum cyst. We found ECT to be safe and effective in adolescents with severe and medication-resistant mental illnesses.