A Systematic Review of the Safety of Electroconvulsive Therapy Use During the First Trimester of Pregnancy

Calaway, Katherine; Coshal, Shana; Jones, Kristin; Coverdale, John; Livingston, Robin

doi:10.1097/yct.0000000000000330

Cited by 23 publications

(28 citation statements)

References 20 publications

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“…Another aspect to consider is that the studies in this review have generally included unselected ECT populations encompassing young and old, as well as those with or without somatic comorbidities. It is therefore worth noting that ECT is generally also considered to be safe in adolescents , the elderly , the pregnant , and individuals with cardiovascular disease , pulmonary disease , and intracranial masses .…”

Section: Discussionmentioning

confidence: 99%

The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis

Torring

Sanghani

Petrides

et al. 2017

Acta Psychiatr Scand

124

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Section: Discussionmentioning

confidence: 99%

The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis

Torring

Sanghani

Petrides

et al. 2017

Acta Psychiatr Scand

124

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“…There have been five systematic reviews of the safety of ECT in pregnancy since 2015 (Calaway et al, 2016; Coshal et al, 2019; Leiknes et al, 2015; Sinha et al, 2017; Spodniakova et al, 2015), with Calaway et al, focusing on the safety of ECT in the first trimester. These overlapping reviews examined several hundred case reports and concluded that ECT in pregnancy was relatively safe.…”

Section: Treatmentsmentioning

confidence: 99%

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Malhi

Bell

Bassett³

et al. 2020

Aust N Z J Psychiatry

312

365

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Objectives: To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. Methods: Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. Results: The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. Conclusion: The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. Mood disorders committee: Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.

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“…The authors of a meta-review listed fetal bradycardia/arrhythmia, premature birth, development delay, abdominal pain, uterine contraction, vaginal bleeding, placental abruption as the most frequent events that occurred when treating pregnant patients with ECT, but after analyzing the available data, they ended up supporting the fact that the administration of ECT in pregnancy is relatively safe (92). The same conclusion was drawn after research activity on ECT used in the first trimester of pregnancy, when only 1 patient out of 32 experienced a threatened abortion (93).…”

Section: Electroconvulsive Therapy (Ect)mentioning

confidence: 87%

Affective disorders: A question of continuing treatment during pregnancy (Review)

2020

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Fetal development, especially in the first trimester, has proven to be heavily influenced by external factors, such as chemical intake of medication. Chronic psychiatric treatment might interfere with the anatomical and physiological wellbeing of the fetus, because psychotropic medication proceeds past the placenta, into the amniotic fluid, and can enter breast milk. Hence some of the medications prescribed for mood disorders should be reconsidered during pregnancy, without sub-optimally treating when it is needed. A literature review is presented which systematically collects modern data and synthesizes previous interdisciplinary research findings on the safety of psychiatric treatment for affective disorders during pregnancy (term-based) and lactation. Antidepressants and mood stabilizers, fundamental strategies in treating affective disorders, have been classified by the FDA as C respectively D drugs pertaining to their risk, with some exception. Most guidelines recommend pharmacologically treating moderate-severe depression, preferably with SSRIs. Evidence advocates that drugs should be used during pregnancy only if clearly needed and the benefit outweighs the risk to the fetus. However, guidelines the American College of Obstetricians and Gynecologists state that antidepressants are a preferred first course of treatment and does not take into account the severity of the depression. Among mood-stabilizers, lithium is considered to be the safest option for pregnant women. Anticonvulsants have a higher risk of teratogenicity compared with lithium, with lamotrigine being the safest one. All mood stabilizers should be recommended in the lowest effective doses. There is controversy regarding the safety of second-generation antipsychotics during pregnancy and further research is required. Several case reports and meta-reviews have been published in order to emphasize the safety of electroconvulsive therapy (ECT) during pregnancy, but practitioners still stigmatize this procedure. Evaluating the overall risk-benefit ratio should be assessed by the medical care provider, taking into consideration current findings.

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A Systematic Review of the Safety of Electroconvulsive Therapy Use During the First Trimester of Pregnancy

Cited by 23 publications

References 20 publications

The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis

The mortality rate of electroconvulsive therapy: a systematic review and pooled analysis

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

Affective disorders: A question of continuing treatment during pregnancy (Review)

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