Acute and maintenance electroconvulsive therapy for treatment of psychotic depression in a pregnant patient.

Depression may relapse during pregnancy in women with a history of depression. Treatments which may be effective for mothers may be harmful to the fetus. Electroconvulsive therapy (ECT) has been widely used in patients with different medical illnesses. It is safe, and its efficacy is well established. In our example, the patient was a 34-year-old white woman who was at 13 weeks' gestation at the time of admission to our hospital. Over a 1-month period, the patient underwent a total of 13 ECTs (3 times a week) and 3 more ECTs monthly until the birth of her child. After 10th ECT, the Hamilton Depression Rating Scale score was reduced from 33 before ECT to 7. After 3 more weekly ECTs, the patient was discharged from the hospital with a Hamilton Depression Rating Scale score of 3. The patient was instructed to continue maintenance treatment with ECT sessions monthly. Except for pelvic pain and transient fetal arrhythmias, no complications were reported. Thus, acute and maintenance ECT may be the choice of treatment in severely depressed or psychotic pregnant patients.