ECT in Pregnancy


Out on PubMed, from clinicians in Göttingen, Germany is this case report and review:[Electroconvulsive therapy in pregnancy: case report and interdisciplinary treatment suggestions].
Zilles-Wegner D, Trost S, Walliser K, Saager L, Horn S, Ernst M.Nervenarzt. 2020 Jul 17. doi: 10.1007/s00115-020-00960-7. Online ahead of print.PMID: 32681216 
The abstract is copied here:
Background: Psychiatric disorders during pregnancy are common. Electroconvulsive therapy (ECT) can be indicated in severely affective or psychotic disorders with the necessity of a rapid response. Currently available review articles greatly differ in the methodology, leading to divergent conclusions concerning the use of ECT during pregnancy.

Objective: Description of a new clinical case and interdisciplinary treatment suggestions for the safe application of ECT in pregnancy.

Methods: Clinical case report and selective review of the literature with special consideration of existing systematic reviews.

Results and conclusion: This case report shows the potentially high effectiveness and safe administration of ECT in pregnancy for both mother and fetus. The undesired adverse events associated with ECT described in the literature are largely qualitatively congruent with the risks of severe psychotic disorders in pregnancy per se. For a better risk-benefit analysis, larger case control studies would be desirable. Under the premise of a thorough evaluation of the indications, good interdisciplinary coordination and consideration of the specific practical requirements, ECT is a useful therapeutic option in pregnancy.

Keywords: Anesthesia; Effectiveness; Neonatology; Obstetric

The pdf, in German, is here.
This case report and review of ECT in pregnancy is a timely reminder of this special indication for ECT. With good collaborative, interdisciplinary care, ECT in pregnancy is safe and often life-saving. 
The same is true for ECT to treat severe postpartum depression and postpartum psychosis. Many will remember the tragic story of Andrea Yates, who drowned her 5 young children during an episode of postpartum psychosis in Texas, in 2001. Reluctance to prescribe ECT in a timely fashion likely contributed to that horrific outcome. Please see also blog post of April 1, 2020 for discussion of another recent review article about ECT in pregnancy.

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