The Efficacy of Electroconvulsive Therapy in Major Depressive Disorder Relapsed or Unresponsive to Transcranial Magnetic Stimulation in Pregnancy: Three Case Studies

Eylem Ozten¹, Gokben Hızlı Sayar^1, , Işıl Gögcegöz Gül¹, Ali Evren Tufan², Cem Cerit³ and Nesrin Dilbaz¹

¹Uskudar University Medical Faculty, Department of Psychiatry, Istanbul, Turkey

²AbantIzzetBaysal University Medical Faculty, Department of Child and Adolescent Psychiatry, Bolu, Turkey

³Kocaeli University Medical Faculty, Department of Psychiatry, Kocaeli, Turkey

Cite this paper:
Eylem Ozten, Gokben Hızlı Sayar, Işıl Gögcegöz Gül, Ali Evren Tufan, Cem Cerit and Nesrin Dilbaz. The Efficacy of Electroconvulsive Therapy in Major Depressive Disorder Relapsed or Unresponsive to Transcranial Magnetic Stimulation in Pregnancy: Three Case Studies. American Journal of Clinical Medicine Research. 2014; 2(1):18-21. doi: 10.12691/ajcmr-2-1-5

Abstract

About 5-10% of women experience depression during pregnancy. The potentially adverse effects of pharmacological treatment (e.g. teratogenicity, toxicity, foetal developmental abnormalities and withdrawal symptoms) on both the mother and the foetus mean that psychopharmacological treatments have limited application for pregnant women. In these cases treatment needs to be tailored to the individual patient and non-pharmacological options may be appropriate. Transcranial Magnetic Stimulation (TMS) and Electroconvulsive treatment (ECT) may be viable alternatives for these patients. We report on three patients in their first trimester of pregnancy suffering from major depressive disorder (MDD). All three were initially treated with TMS and psychotherapy because of the reduced risk of side effects. Two patients failed to respond adequately to treatment and were switched to ECT. The third patient displayed an adequate response to TMS but failed to maintain the improvement. This patient had to receive ECT in the post-partum period due to on-going depressive symptoms. Subsequently this patient responded adequately to ECT. Further studies of novel, non-pharmacological treatment methods for MDD during pregnancy (such as TMS and ECT) and detailed investigations of the factors associated with treatment responses in such patients are needed. Our cases demonstrate the need to evaluate the effectiveness of TMS in larger samples of pregnant patients diagnosed with MDD.

Keywords:
electroconvulsive treatment major depressive disorder pregnancy transcranial magnetic stimulation

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