Electroconvulsive treatment during pregnancy: a systematic review

Abstract

Pharmacological treatment of severe psychiatric disorders during pregnancy is complicated by the potential harmful effects of treatment for the fetus. Electroconvulsive therapy (ECT) has been demonstrated to be effective for the treatment of several mental disorders. The aim of this study was to investigate the safety of ECT in the treatment of psychiatric disorders during pregnancy; to compare its efficacy with medication; and to identify the main indications for use in pregnancy. We performed a careful and systematic review of the literature on ECT and pregnancy was conducted. Almost all patients demonstrated total or at least partial remission of symptoms after ECT treatment. No deaths were reported in ECT-treated pregnant women. We conclude that ECT is probably currently under-used in many psychiatric settings because of its stigmatized perception by patients and by mental health professionals. ECT seems to be effective for treating major psychiatric disorders during pregnancy, and the risks of adverse events are low.

Keywords::

• ECT
• pregnancy
• psychiatric disorders
• psychopharmacology
• side effect

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Severe psychiatric disorders are relatively common during pregnancy, with some studies reporting a morbidity of 15–29% among all pregnant women.

• Pharmacological treatment of severe psychiatric disorders during pregnancy is complicated by the potential harmful effects of the treatment for the fetus (e.g., teratogenicity, toxicity and withdrawal syndromes).

• Many authors have indicated the efficacy and the safety of electroconvulsive therapy (ECT) during all trimesters of pregnancy.

• Depressed women treated with ECT have a full or partial response to treatment in 84% of cases. In schizophrenic women treated with ECT, this rate of response is 61%.

• The most common adverse effects in mothers are confusion, memory loss, muscle soreness, headache, hypertension, vaginal bleeding, placental abruption, uterine contractions and induction of premature labor.

• The most common adverse effects in the fetus are transient fetal heart rate decreases, multiple cortical infarcts, ascites, transposition of great vessels, stillbirth and neonatal death.

• The indication for ECT in pregnant women is to replace drug therapy in patients who cannot continue pharmacological treatment for their disorder (major depression, bipolar disorder, suicidal crises) or to prevent the side effects of psychiatric drugs in the mother and teratogenicity and toxicity in the fetus.

• The efficacy and safety of ECT seems good as compared with pharmacotherapy.

Notes

¹Dr. Naser Ahmadi and colleagues. American Psychiatric Association 2014 Annual Meeting. Abstract SCR14-4. Presented Monday, 5 May 2014.