Electroconvulsive Therapy During Pregnancy and Postpartum [Part 5] ECT in Perinatal Period

Psychiatric disorders are common in pregnancy, affecting 15-29% of pregnant women. Untreated depression has negative health consequences for mother and fetus. Electroconvulsive therapy (ECT) is an effective option for the treatment of severe depression, high suicide risk, catatonia, medication-resistant illness, psychotic agitation, severe physical decline, and other life-threatening conditions.

Electroconvulsive therapy (ECT) is a form of psychiatric treatment that involves inducing seizures with the use of electrical stimulation while an individual is under general anesthesia. ECT is primarily indicated in people who require a rapid treatment response due to the severity of their condition such as violent patients or risk for suicide or catatonia. ECT has also been shown to be relatively safe during pregnancy and may offer some advantages over antidepressants in minimizing exposure to psychotropic medications during pregnancy.

While the patient is under full general anesthesia, a muscle relaxant is given and electrodes are applied to the scalp. A brief electrical stimulus is delivered. The effective stimuli produce a mild seizure which changes the activity of the brain. The brain stimulation is accompanied by mild muscle contractions usually lasting less than one minute.

The risks associated with ECT during pregnancy and post-partum are similar to those observed in non-pregnant individuals receiving ECT and include transient memory disruption, confusion, nausea and vomiting, muscle soreness, and headaches.

The indication and appropriateness of ECT in pregnancy must be carefully weighed against the risks of untreated maternal illness and those of alternative treatment options. The safety of ECT in pregnancy has been documented over the last 50 years. The adverse effects in pregnancy are similar to the risks of ECT in any individual. The most common risk to the mother is premature contractions and preterm labor, which occur infrequently and are not clearly caused by ECT. The rates of miscarriages were not significantly different from that of the general population. There have been no associations of ECT with congenital anomalies, either morphologic or behavioral, and no neurocognitive disturbances in the child

ECT is a reasonably safe, rapid resolution of symptoms and effective treatment for management of many psychiatric disorders in pregnant patients and also during post-partum period. For women with less severe depression, ECT may not be an attractive option. However, for women with severe psychiatric symptoms, including suicidality, psychosis, infanticidal, homicidal or manic/mixed symptoms, ECT should be considered as a first line treatment.