Electroconvulsive therapy (ECT) is a medical procedure performed under general anesthesia to treat severe mental health conditions. It involves passing small, controlled electrical currents through the brain to intentionally induce a brief seizure. This process is understood to alter brain chemistry and lead to rapid improvements in symptoms. The treatment is administered by a specialized medical team, including a psychiatrist, an anesthesiologist, and a nurse. A course of treatment generally involves multiple sessions, often two to three times per week for several weeks.
Despite a historical stigma, modern ECT is a safe treatment with significantly fewer risks than its early applications.
Indications for ECT During Pregnancy
The use of ECT during pregnancy is reserved for severe psychiatric conditions where the illness’s risks outweigh the procedure’s potential risks. One primary indication is severe major depression, especially when accompanied by psychosis, a refusal to eat, or a high risk of suicide. Untreated, this depression can lead to poor maternal self-care, malnutrition, and self-harm, threatening both mother and fetus.
ECT is also a treatment for catatonia, a state where an individual may be unable to move or speak, which can become medically dangerous. Another indication is acute mania associated with bipolar disorder, where impulsive behaviors can endanger the patient and her pregnancy. The mother’s illness can also expose the fetus to high levels of stress hormones, which may negatively affect development.
ECT may be considered when psychotropic medications are unsuitable. This occurs if a patient has not responded to medication, has a history of severe side effects, or if the required medications pose a significant risk to the fetus.
Maternal and Fetal Safety Considerations
For the mother, the primary risks are related to general anesthesia and the induced seizure. These include temporary cardiovascular changes, like an increased heart rate, and the risk of aspiration, the inhalation of stomach contents into the lungs. These risks are managed by the anesthesiologist through medication and by requiring the patient to fast.
For the fetus, concerns include miscarriage or preterm labor, but observation suggests these risks are low when safety protocols are followed. The electrical current is focused on the brain and does not pass through the uterus, posing no direct shock risk to the fetus. The seizure is brief, and medications for anesthesia and muscle relaxation are chosen for their short duration and minimal transfer across the placenta.
To ensure fetal well-being, a robust monitoring plan is put in place. This includes continuous electronic fetal heart rate and uterine contraction monitoring before, during, and for a period afterward in the recovery area to detect any signs of fetal distress.
The ECT Procedure with Pregnancy Modifications
Before the first treatment, the patient undergoes a comprehensive evaluation by both the psychiatric team and an obstetrician to confirm that ECT is appropriate. To prevent supine hypotensive syndrome, where the uterus can compress the vena cava and restrict blood flow, a wedge is placed under the patient’s right hip. This positioning tilts the uterus to the left, maintaining healthy circulation.
An intravenous line is placed to administer a rapid-acting general anesthetic and a muscle relaxant, ensuring the patient is asleep and feels no pain. Once anesthetized, the psychiatrist places electrodes on the scalp and delivers a brief electrical stimulus. This induces a generalized seizure that is monitored via electroencephalogram (EEG) and lasts less than two minutes.
Because of the muscle relaxant, the physical manifestation of the seizure is minimal, often just a slight movement in the hands or feet. The patient is then moved to a recovery area for close monitoring as the anesthesia wears off.
Post-Treatment Care and Outlook
In the short term, some individuals experience side effects like headaches, muscle aches, or nausea, which are mild and managed with medication. The most discussed side effect is memory difficulty, including trouble forming new memories (anterograde amnesia) and recalling past events (retrograde amnesia). These memory issues are temporary and improve in the weeks and months after treatment is completed.
Once acute symptoms resolve, the focus shifts to a long-term management strategy developed collaboratively with the psychiatric team. For some, this may involve continuing maintenance ECT sessions at a reduced frequency to prevent a relapse. For others, the plan may involve starting or reintroducing psychotropic medication after the baby is delivered.
The goal is a sustainable plan for mental wellness, which often includes psychotherapy and other support systems to help the patient navigate her condition and the transition into motherhood.