This is a small case report but is an important one, demonstrating the effectiveness of ultra-brief electroconvulsive therapy (ECT) for the treatment of severe postpartum depression. While most women with postpartum illness have mild to moderate illness, there are some women with severe depression that significantly impairs their ability to function and to care for their child. Women with severe PPD are also at higher risk for suicide.
In this report, 3 women with severe postpartum depression, refractory to treatment with medication, were psychiatrically hospitalized. All three patients had significant suicidal ideation. They were treated with right unilateral ultra-brief ECT. (Ultra-brief ECT consists of electrical pulses lasting less than 0.5 milliseconds and causes less memory impairment than ECT treatments with longer pulses.) All women began to respond within 3–6 treatments (within 1-2 weeks), and no significant cognitive side effects were observed.
Although ECT is rarely thought of as first line treatment, this report suggests its usefulness in the management of women with severe PPD. For women with severe depression, psychiatric hospitalization may be necessary. However, in the United States where mother-baby units are rare, hospitalization often necessitates a prolonged separation of the mother from her infant. Medications typically take 2-4 weeks to start working, and sometimes the illness is refractory to treatment with medications. This case series suggests that ECT is not only effective in this setting but also yields quick results.
Ruta Nonacs, MD PhD
Levy Y, Austin MP, Halliday G. Use of ultra-brief pulse electroconvulsive therapy to treat severe postnatal mood disorder. Australas Psychiatry, 2012.
Focht A, Kellner CH. Electroconvulsive therapy (ECT) in the treatment of postpartum psychosis. J ECT. 2012 Mar;28(1):31-3. (Review)