Use of electroconvulsive therapy (ECT) in postpartum psychosis—a naturalistic prospective study

Abstract

Postpartum psychosis (PPP) is a severe psychiatric condition requiring rapid restoration of health in view of significant risks to both mother and the infant. Electroconvulsive therapy (ECT) is often used for treatment of severe PPP. The aims of the study were to describe the indications for ECT among women admitted with PPP to a psychiatric hospital in India. It also aimed at assessing whether women with PPP who received ECT differed in their clinical history, diagnosis, severity of illness, psychopathology, drug dosage, and duration of hospital stay, compared to women who did not receive ECT. Infants of mothers who were breast-feeding their infants while receiving ECT were assessed for adverse effects. This was a naturalistic prospective study of 78 women admitted with PPP, 34 (43.6 %) of whom received ECT. Presence of catatonia, augmentation of medications, and suicidality were common indications for ECT. Catatonic symptoms were significantly higher among women who received ECT. There was no significant difference in duration of hospitalization or severity of psychopathology between women who did and did not receive ECT. Transient side effects to ECT were observed in few women, with no adverse effects noted in infants who were breast-fed. The current study supports the use of ECT as an effective and safe treatment for women with severe PPP.

Obstetric Characteristics and Management of Patients with Postpartum Psychosis in a Tertiary Hospital Setting

“…ECT becomes the therapeutic option where risk of infanticide, suicide, or refusal to take drugs is high. Some studies advocate the use of ECT as first line treatment in selected cases [ 25 ] while others recommend pharmacotherapy [ 26 ].…”

Postpartum psychiatric disorders

“…Moreover, this study demonstrated that lithium monotherapy is protective against relapse of psychosis, depression and mania within one year. The second largest study described successful ECT treatment in 34 patients with postpartum psychosis of whom many had symptoms of catatonia 204 . The effectiveness of lithium and ECT is supported by case reports 205 .…”

Treatment-resistant, five-year long, postpartum-onset Capgras episode resolving after electroconvulsive therapy

“…36,37 ECT is also the treatment of choice in severe and refractory cases of postpartum psychosis and postpartum depression. 17,38,39 ECT followed by a mood stabilizer-antipsychotic combination obtained a rapid resolution of postpartum Capgras syndrome in a young patient. Consultant psychiatrists should be aware of this therapeutic option.…”