Use of modified bilateral electroconvulsive therapy during pregnancy: A case series

Abstract

There is limited literature on the use of electroconvulsive therapy (ECT) during pregnancy. ECT is considered as a treatment of last resort during pregnancy. In this case series, we present the data of five patients who were administered ECT during pregnancy. The use of ECT required multidisciplinary approach involving psychiatrist, gynecologist, anesthetist and neonatologist. Two patients received ECT during the second trimester and three patients received ECT during the third trimester. In all the patients, ECT was administered by placing the patients in the left lateral position, glycopyrrolate was used for premedication, thiopentone was used for induction, and succinylcholine was used for muscle relaxation. Patients who were administered ECT close to the full-term were given injection betamethasone 12 mg intramuscularly on two consecutive days before starting of first ECT to promote fetal lung maturity. In all the five cases, no adverse maternal and fetal outcomes were encountered except for possible precipitation of labor in one case.

Safety of electroconvulsive therapy (ECT) in pregnancy: a systematic review of case reports and case series

“…These complications included transient changes in heart rate and rhythm, blood pressure, uterine contractions, fetal spasms, pelvic pain, and the appearance of mild symptoms of hypomania. Among these, transient fetal arrythmias and uterine contractions were the most frequent, reported 10 (Varan et al 1985 ; Bhatia et al 1999 ; DeBattista et al 2003 ; Bozkurt et al 2007 ; De Asis et al 2013 ; Halmo et al 2014 ; Moosavi Rineh et al 2020 ; Rabie et al 2021 ; Bhasin et al 2022 ; Patel et al 2022 ) and four times (Bhatia et al 1999 ; Bulbul et al 2013 ; Grover et al 2017 ; Rabie et al 2021 ), respectively. Moderate-grade complications were those that have not had a rapid resolution and/or have required medical intervention; the most frequent was preterm birth, reported in seven papers (Livingston et al 1994 ; Pinette et al 2007 ; Kasar et al 2007 ; Yang et al 2011 ; Bulut et al 2013 ; Ray-Griffith et al 2016 ; Bhasin et al 2022 ).…”

“…The number of ECT sessions, when indicated, was very heterogeneous ranging from a minimum of one session (Ray-Griffith et al 2016) to a maximum of 23 sessions (Rabie et al 2021). When reported, the efficacy of ECT was confirmed by these case series (Simon 1948;Laird 1955;Smith 1956;Bhatia et al 1999;Bulbul et al 2013;Halmo et al 2014;Ray-Griffith et al 2016;Grover et al 2017;Rabie et al 2021). Only two studies reported a lack of efficacy of ECT in ameliorating symptoms: ECT failure in 5 out of 33 cases included in Bulbul (Bulbul et al 2013) and in 11 of 12 cases included in Bulut (Bulut et al 2013).…”

A Case Report of Acute Cervical Dystonia After Electroconvulsive Therapy

“…Electroconvulsive therapy (ECT) is a widely accepted and effective treatment for major depression and other psychiatric disorders. Furthermore, treatment gains have been reported in neurological disorders such as Parkinson disease (PD), neuroleptic malignant syndrome, epileptic seizures, and, proposedly, tardive dyskinesia and dystonia 1,2 . In contrast to the reported beneficial effects of ECT on dystonia, we describe the occurrence of acute postprocedure cervical dystonia.…”

“…Individuals with PD are more vulnerable to develop (acute) dystonia because of a lack of dopamine, but based on the current literature, they are not considered to be more susceptible to developing dystonia as a result of ECT. On the contrary, ECT has been shown to improve motor symptoms in PD 2 . Some reports even suggest that, in PD, higher symptom severity and older age are associated with a better motor response to ECT.…”

“…Some reports even suggest that, in PD, higher symptom severity and older age are associated with a better motor response to ECT. Still, although PD is not taken as a contraindication for treatment with ECT, 2 patients with depression and PD appear to be more sensitive to adverse effects (mainly delirium), making close monitoring during treatment even more essential.…”