This paper reviews all reports of Cotard's syndrome (délire de négation) in adolescents and young adults and summarizes four consecutive cases seen at our institution during the past 10 years. Cotard's syndrome occurs infrequently in young people (19 cases have been reported so far, including a 15-year-old boy who died at hospital) but appears to be a severe syndrome in adolescents of both genders. Ten patients received electroconvulsive therapy (ECT) despite their young age. Among the 14 cases reported with at least a 2-year follow-up, 13 patients (93%; 11 female) exhibited a bipolar outcome. The use of mood stabilizers should be considered in this rare, but potentially severe, condition.