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Systematic review / Primary study

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

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Journal The journal of ECT
Year 2016
Links Pubmed DOI

This article is included in 2 Broad syntheses 13 Broad syntheses (2 references)

This article includes 13 Primary studies 13 Primary studies (13 references)

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OBJECTIVES: Because of the lack of focus on the safety of electroconvulsive therapy (ECT) during the first trimester of pregnancy in current literature, we set out to assess the safety of ECT use during this vital period of fetal development. METHODS: A systematic review was conducted, and a case where ECT was employed during the first trimester was presented. Cochrane Library, Ovid MEDLINE, PsycINFO, and PubMed were independently searched by 2 authors using the following search terms: "ECT," "electroconvulsive therapy," "electroshock" combined with "pregnancy," "first trimester of pregnancy," and "teratogenicity." RESULTS: Of the 97 articles reviewed, 13 met inclusion criteria. We identified 32 first-trimester patients as cases or case series. Adverse outcomes, including miscarriage with previous vaginal bleeding, vaginal bleeding, self-limited abdominal pain, and self-limited fetal spasms, were observed. We added 1 case of a pregnant patient at approximately 9 weeks gestation who experienced a threatened abortion after the administration of ECT. CONCLUSIONS: Although the data are limited, they suggest that ECT is relatively safe when administered during the first trimester of pregnancy. The possible adverse consequences of ECT during the first trimester of pregnancy should be carefully weighed against the potential benefits of ECT on untreated mental illness.

Systematic review

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Electroconvulsive therapy during pregnancy: a systematic review of case studies.

Journal Archives of women's mental health
Year 2015
Links Pubmed DOI PubMed Central

This article is included in 3 Broad syntheses 67 Broad syntheses (3 references)

This article includes 67 Primary studies 67 Primary studies (67 references)

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This study aims to explore practice, use, and risk of electroconvulsive therapy (ECT) in pregnancy. A systematic search was undertaken in the databases Medline, Embase, PsycINFO, SveMed and CINAHL (EBSCO). Only primary data-based studies reporting ECT undertaken during pregnancy were included. Two reviewers independently checked study titles and abstracts according to inclusion criteria and extracted detailed use, practice, and adverse effects data from full text retrieved articles. Studies and extracted data were sorted according to before and after year 1970, due to changes in ECT administration over time. A total of 67 case reports were included and studies from all continents represented. Altogether, 169 pregnant women were identified, treated during pregnancy with a mean number of 9.4 ECTs, at mean age of 29 years. Most women received ECT during the 2nd trimester and many were Para I. Main diagnostic indication in years 1970 to 2013 was Depression/Bipolar disorder (including psychotic depression). Missing data on fetus/child was 12 %. ECT parameter report was often sparse. Both bilateral and unilateral electrode placement was used and thiopental was the main anesthetic agent. Adverse events such as fetal heart rate reduction, uterine contractions, and premature labor (born between 29 and 37 gestation weeks) were reported for nearly one third (29 %). The overall child mortality rate was 7.1 %. Lethal outcomes for the fetus and/or baby had diverse associations. ECT during pregnancy is advised considered only as last resort treatment under very stringent diagnostic and clinical indications. Updated international guidelines are urgently needed.

Systematic review

Unclassified

Electroconvulsive treatment during pregnancy: a systematic review.

Journal Expert review of neurotherapeutics
Year 2014
Links Pubmed DOI

This article is included in 3 Broad syntheses 34 Broad syntheses (3 references)

This article includes 34 Primary studies 34 Primary studies (34 references)

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Pharmacological treatment of severe psychiatric disorders during pregnancy is complicated by the potential harmful effects of treatment for the fetus. Electroconvulsive therapy (ECT) has been demonstrated to be effective for the treatment of several mental disorders. The aim of this study was to investigate the safety of ECT in the treatment of psychiatric disorders during pregnancy; to compare its efficacy with medication; and to identify the main indications for use in pregnancy. We performed a careful and systematic review of the literature on ECT and pregnancy was conducted. Almost all patients demonstrated total or at least partial remission of symptoms after ECT treatment. No deaths were reported in ECT-treated pregnant women. We conclude that ECT is probably currently under-used in many psychiatric settings because of its stigmatized perception by patients and by mental health professionals. ECT seems to be effective for treating major psychiatric disorders during pregnancy, and the risks of adverse events are low.

Systematic review

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Treating bipolar depression - Antidepressants and alternatives: A critical review of the literature

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Journal Acta neuropsychiatrica
Year 2011
Links Pubmed DOI

This article includes 124 Primary studies 125 Primary studies (124 references)

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Objective: Although depressive symptoms are preponderant in the course of bipolar (BP) disorders, the treatment of BP depression remains a controversial issue with different clinical approaches available. This review addresses the issues of whether antidepressants (ADs) are effective in treating acute and long-term BP depression, risks linked to ADs and what alternatives to ADs are available. Methods: We searched the MEDLINE databases using the following syntax: [bipolar depression AND unipolar depression AND (antidepressants OR anticonvulsants OR lithium OR antipsychotics OR dopamine-agonists OR psychoeducation OR psychotherapy OR electroconvulsive therapy OR transcranial magnetic stimulation)]. The search included studies published up to 31 May 2009 and conducted on adults. Results: In the acute treatment of BP depression ADs are effective with no differences among drug classes. However, neither the switch into (hypo)mania induction rate nor the suicide risk linked to AD use are definitely established. The effectiveness of long-term AD use is limited to highly selected samples of patients with positive acute response. The risk of long-term ADs causing cycle acceleration and rapid cycling induction concerns a subpopulation of patients. Valid alternatives to ADs in treating acute BP depression are quetiapine, an olanzapine-fluoxetine combination, and electroconvulsive therapy for more severe patients. Lamotrigine is effective and safe in preventing depressive relapses. Psychotherapy and psychoeducation represent effective adjunctive treatments. Conclusion: In the treatment of BP depression there is not a specific effective treatment for all the patients. Interventions should therefore be personalised and the scientific evidence should be adapted to each patient's clinical features. © 2011 John Wiley & Sons A/S.

Systematic review

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Continuation and maintenance electroconvulsive therapy for mood disorders: Review of the literature.

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Journal Neuropsychobiology
Year 2011
Links Pubmed DOI PubMed Central

This article includes 32 Primary studies 32 Primary studies (32 references)

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BACKGROUND: Electroconvulsive therapy (ECT) is a highly effective treatment for mood disorders. Continuation ECT (C-ECT) and maintenance ECT (M-ECT) are required for many patients suffering from severe and recurrent forms of mood disorders. This is a review of the literature regarding C- and M-ECT. METHODS: We conducted a computerized search using the words continuation ECT, maintenance ECT, depression, mania, bipolar disorder and mood disorders. We report on all articles published in the English language from 1998 to 2009. RESULTS: We identified 32 reports. There were 24 case reports and retrospective reviews on 284 patients. Two of these reports included comparison groups, and 1 had a prospective follow-up in a subset of subjects. There were 6 prospective naturalistic studies and 2 randomized controlled trials. CONCLUSIONS: C-ECT and M-ECT are valuable treatment modalities to prevent relapse and recurrence of mood disorders in patients who have responded to an index course of ECT. C-ECT and M-ECT are underused and insufficiently studied despite positive clinical experience of more than 70 years. Studies which are currently under way should allow more definitive recommendations regarding the choice, frequency and duration of C-ECT and M-ECT following acute ECT. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Systematic review

Unclassified

Antipsychotic therapy during early and late pregnancy. A systematic review.

Authors Gentile S
Journal Schizophrenia bulletin
Year 2010
Links Pubmed DOI PubMed Central

This article includes 109 Primary studies 109 Primary studies (109 references)

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OBJECTIVE: Both first- (FGAs) and second-generation antipsychotics (SGAs) are routinely used in treating severe and persistent psychiatric disorders. However, until now no articles have analyzed systematically the safety of both classes of psychotropics during pregnancy. DATA SOURCES AND SEARCH STRATEGY: Medical literature information published in any language since 1950 was identified using MEDLINE/PubMed, TOXNET, EMBASE, and The Cochrane Library. Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from companies developing drugs. Search terms were pregnancy, psychotropic drugs, (a)typical-first-second-generation antipsychotics, and neuroleptics. A separate search was also conducted to complete the safety profile of each reviewed medication. Searches were last updated on July 2008. DATA SELECTION: All articles reporting primary data on the outcome of pregnancies exposed to antipsychotics were acquired, without methodological limitations. CONCLUSIONS: Reviewed information was too limited to draw definite conclusions on structural teratogenicity of FGAs and SGAs. Both classes of drugs seem to be associated with an increased risk of neonatal complications. However, most SGAs appear to increase risk of gestational metabolic complications and babies large for gestational age and with mean birth weight significantly heavier as compared with those exposed to FGAs. These risks have been reported rarely with FGAs. Hence, the choice of the less harmful option in pregnancy should be limited to FGAs in drug-naive patients. When pregnancy occurs during antipsychotic treatment, the choice to continue the previous therapy should be preferred.

Systematic review

Unclassified

ECT in pregnancy: a review of the literature from 1941 to 2007.

Authors Anderson EL , Reti IM
Journal Psychosomatic medicine
Year 2009
Links Pubmed DOI

This article is included in 1 Structured summary of systematic reviews 57 Structured summaries of systematic reviews (1 reference) 3 Broad syntheses 57 Broad syntheses (3 references)

This article includes 57 Primary studies 57 Primary studies (57 references)

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OBJECTIVE: To review the literature on the use of electroconvulsive therapy (ECT) during pregnancy and to discuss its risks and benefits for treating severe mental illness during pregnancy. METHOD: PubMed and PsycINFO databases were searched for English or English-translated articles, case reports, letters, chapters, and Web sites providing original contributions and/or summarizing prior data on ECT administration during pregnancy. RESULTS: A total of 339 cases were found. The majority of patients were treated for depression and at least partial remission was reported in 78% of all cases where efficacy data were available. Among the 339 cases reviewed, there were 25 fetal or neonatal complications, but only 11 of these, which included two deaths, were likely related to ECT. There were 20 maternal complications reported and 18 were likely related to ECT. CONCLUSIONS: Although there are limited available data in the literature, it seems that ECT is an effective treatment for severe mental illness during pregnancy and that the risks to fetus and mother are low.

Systematic review

Unclassified

Use of electroconvulsive therapy during pregnancy.

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Authors Miller LJ
Journal Hospital & community psychiatry
Year 1994
Links Pubmed

This article is included in 4 Broad syntheses 31 Broad syntheses (4 references)

This article includes 31 Primary studies 31 Primary studies (31 references)

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OBJECTIVE: Untreated major mood disorders during pregnancy pose significant risks. The author reviews case reports of the use of electroconvulsive therapy (ECT) during pregnancy to clarify potential risks and modifications of ECT techniques that make the procedure safer for pregnant women. METHODS: A total of 300 case reports of ECT during pregnancy drawn from the literature from 1942 through 1991 were reviewed. RESULTS: Twenty-eight of the 300 cases reported complications associated with ECT during pregnancy, including transient, benign fetal arrhythmias; mild vaginal bleeding; abdominal pain; and self-limited uterine contractions. Without proper preparation, there was also increased likelihood of aspiration, aortocaval compression, and respiratory alkalosis. CONCLUSIONS: Electroconvulsive therapy is a relatively safe and effective treatment during pregnancy if steps are taken to decrease potential risks. Preparation for ECT during pregnancy should include a pelvic examination, discontinuation of nonessential anticholinergic medication, uterine tocodynamometry, intravenous hydration, and administration of a nonparticulate antacid. During ECT, elevation of the pregnant woman's right hip, external fetal cardiac monitoring, intubation, and avoidance of excessive hyperventilation are recommended. Informed consent for ECT should include the patient's capacity to understand and rationally evaluate risks and benefits to herself and the fetus.