A systematic review including 60 observational studies or case reports with a total of 396 subjects below 18 years of age was abstracted in DARE. Overall 53% of 154 patients for whom data on diagnosis and outcome were available showed improvement or remission of symptoms. This rises to 67% when patients with mild or moderate response to treatment are included. Improvement generally occurred early in the course of treatment (mean = 3.7 days). No fatalities due to ECT were described. The rate of lengthy seizures does not seem to be greater than the 1.1% reported for adults.