Efficacy of electroconvulsive therapy (ECT) in the first trimester of pregnancy: A case of manic patient

Abstract

Women with bipolar disorder have a risk for symptom exacerbation during pregnancy. ECT is an appropriate option for psychiatric symptoms during pregnancy although it is often neglected. We report a case of bipolar, week 6 of gestation woman who discontinued medication in the second week of pregnancy but resumed pharmacotherapy with ECT due to manic episode that recurred during the first trimester. Case A 23-year-old female, with a history of one psychiatric hospitalization (a manic episode three years ago) and lithium 900mg/day, olanzapine 5mg/day use for three years until week 2 of gestation admitted to clinic with complaints of decreased need for sleep, increased speech, lability of emotions, religious delusions and irritability for the last two weeks. Young Mani Score (YMS) was 32. ECT, which was considered as the first-line treatment, was not carried out due to low pseudocholinesterase (2401). Therefore, olanzapine was reinstated with a dose of up to 20mg/day. Although olanzapine, irritability still continued. Therefore, medication was switched from olanzapine to haloperidol 15mg/day and quetiapine 25mg/day. Due to persistent symptoms, after necessary consultations and family approval taken, she was administered 6 sessions of ECT with oral haloperidole, although low pseudocholinesterase. Since 7 YMS, she was discharged with haloperidol 15mg/day, biperiden 4mg/day and quetiapine 25mg/day. Conclusion This case highlights the effectiveness of ECT in mania during the first trimester of pregnancy. We suggest that ECT might be considered as a valid option for manic episode during pregnancy.