A 48-Year-Old Woman Primigravid via In Vitro Fertilization With Severe Bipolar Depression and Preeclampsia Treated Successfully With Electroconvulsive Therapy

Abstract

Depression in pregnancy is difficult to treat due to potential adverse effects of medication on both the fetus and the mother. This is further complicated in older women, women with severe or treatment-resistant mental illness, and women with medical complications. Bipolar disorder can present with mania or depression and carries significant risk of impairment, including suicide. In addition, maternal depression adversely affects the development of the child. Depression during pregnancy is especially dangerous and can lead to suicide or infanticide. Treatment is critical. However, medication can present significant risks to the fetus. Therefore, conservative treatment is often the rule. However, especially severe cases require more aggressive approaches. Electroconvulsive therapy (ECT) is one relatively safe and effective option in these complex situations. This case describes a 48 year-old woman, pregnant via in vitro fertilization, with preeclampsia and severe treatment-resistant bipolar depression who responded well to ECT without significant adverse effects to herself or her child. This case highlights the effectiveness of ECT to treat maternal bipolar depression and is the only case, to our knowledge, of the use of ECT after in vitro fertilization in an older primigravid woman.