ECT in the Postpartum Period: Case Series From India
Out on PubMed, from authors in India, is this paper:
Use of electroconvulsive therapy during postpartum: A retrospective chart review.
Background: There is limited data on use of electroconvulsive therapy (ECT) for management of psychiatric disorders during the postpartum period from India.
Aim: We aimed to assess the demographic and clinical profile of patients receiving ECT during the postpartum period for various psychiatric disorders using a retrospective study design.
Methods: ECT register of the department was reviewed for the period of January 2019 to December 2023 to identify the patients who received ECT during the postpartum period. The treatment records of these patients were evaluated to extract the demographic and clinical profile.
Results: During the study period, 10 patients received ECT during the postpartum period. The mean age of the study sample was 27 (standard deviation [SD]: 2.9) years. Majority of the patients were inpatients (70%) at the time of receiving ECT. Five patients were diagnosed with first-episode depression with postpartum onset, and two patients had postpartum-onset psychotic disorder. One patient was diagnosed with recurrent depressive episode and one with bipolar disorder, current episode mania with psychotic symptom, at the time of receiving ECT. The mean number of ECTs during the ECT course was 6.7 (SD: 3.09). Nine out of the 10 patients showed good response to ECT.
Conclusion: Although ECT is less frequently used for management of postpartum psychiatric disorders, its use is associated with significant clinical improvement.
Keywords: Effectiveness; electroconvulsive therapy; postpartum.
DISCUSSION
The present study showed that in 1.1% of the total patients who received ECT, ECT was administered for the postpartum-onset psychiatric syndromes or relapse of psychiatric disorders during the postpartum period. These findings are supported by previous studies which have shown that patients with postpartum-onset psychiatric syndromes or those experiencing relapse of psychiatric disorders during the postpartum period form a very small proportion of total patients and total females receiving ECT.[4,13]
In the present study, the most common indication for ECT during the postpartum period was depression. Previous studies that have evaluated the use of ECT for various postpartum syndromes have also reported use of ECT for postpartum depression.[4,12] Existing literature suggests that depression, suicidality, and catatonia are the most common indications for the use of ECT in patients with postpartum psychiatric syndromes. In the present study too, similar indications were noted for giving ECT. Furthermore, in the present study, in almost all cases, ECT was considered as a treatment option to achieve early treatment response. Previous studies also suggested that ECT is considered during the postpartum period for a significant proportion of patients to achieve early treatment response.[4,6,13,14]
All our patients had significant improvement with the mean number of 6.7 ECTs. Existing data also suggest that patients with postpartum depression and psychosis respond rapidly to ECT with an early and complete remission of symptoms.[4,15,16,17] These findings suggest that ECT should be considered as an option for management of severe postpartum-onset disorders or for patients with severe mental disorders experiencing a relapse in the postpartum period. In the present study, only two of our patients experienced adverse effects with ECT. Previous studies have also reported few adverse effects with ECT when used for postpartum-related psychiatric syndromes.
The present study is limited by the retrospective study design and small sample size.
To conclude, the present study suggests that ECT is effective and safe for the management of postpartum-onset psychiatric syndrome or patients experiencing relapse or exacerbation of severe mental disorders during the postpartum period.
Here is a retrospective case series of 10 patients with postpartum depressive or psychotic illness who received ECT, from a medical center in India. The response was very good, as expected.
Consideration of ECT for severe postpartum affective or psychotic illness is a particularly important use of ECT.
(Please see also blog post of July 23, 2024)
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