Postpartum psychosis is a rare but serious psychiatric illness, occurring in about 1 to 2 per 1000 women after delivery.  Because postpartum psychosis carries significant risks for both the mother and her child, most women with this illness are psychiatrically hospitalized. Electroconvulsive therapy (ECT) is an effective treatment for postpartum psychosis and may reduce the risks associated with medication exposure in the nursing infant; however, very few research studies have focused on the use of ECT in this setting and it is less commonly used in the United States than in other countries.  A recent study explores the safety and advantages of ECT for the treatment of women hospitalized for postpartum psychosis.

In this naturalistic prospective study carried out in India, 78 women were admitted with postpartum psychosis; 34 (43.6 %) of received ECT.  Bitemporal modified ECT was administered using brief pulse stimulus (800 mA; 1 ms; 125 pulses per second).Thiopental (3–4 mg/kg) was used as an anesthetic agent and succinylcholine (0.5–0.75 mg/kg) was used as muscle relaxant.  The median number of ECT was 6.

Catatonia (which was typically associated with decreased intake of food and inability or refusal to take medications) and suicidality were the most common indications for ECT.  The duration of admission in the hospital was lower among women who received ECT (19 vs. 23 days) but was not statistically significant.  Transient side effects to ECT (anterograde amnesia) were observed in few women, with no adverse effects noted in infants who were breastfed while the mother was receiving treatment.

This study indicates that ECT is well-tolerated and effective for the treatment of postpartum psychosis.  While ECT is often reserved for the most severe cases of postpartum illness, this study suggests that it probably should be considered as a first-line treatment for women with postpartum psychosis. Interestingly, in this study ECT did not appear to lead to a significantly shorter hospital stay (as compared to women receiving only medication), but this may stem from the fact that a significant proportion of the women initiated ECT (13/34 or 38%) after they failed to respond adequately to medication.

Ruta Nonacs, MD PhD

Babu GN, Thippeswamy H, Chandra PS. Use of electroconvulsive therapy (ECT) in postpartum psychosis—a naturalistic prospective study.Arch Womens Ment Health. 2013;16(3):247-51.