Maintenance Electroconvulsive Therapy (ECT) for the management of bipolar disorder in pregnancy and the post-partum period: A case report

The management of bipolar disorder during pregnancy and in the post-partum period can often be a challenge for psychiatrists. Psychiatrists and patients must consider both the elevated risks of break-through mood episodes during pregnancy and the post-partum period as well as the potential side effects associated with ongoing pharmacotherapy. Electroconvulsive therapy (ECT) may offer an alternative to pharmacotherapy during pregnancy, though there is very limited information on the use of ECT as a monotherapy or maintenance treatment during pregnancy and in the post-partum period. We present a case of 32 year old woman with bipolar disorder who received maintenance ECT without adjunctive mood stabilizing medications throughout her pregnancy, per patient preference. ECT was found to provide adequate mood stabilization with no adverse effects noted throughout the pregnancy. During the post-partum period which coincided with a brief hiatus of ECTs, the patient experienced a manic episode which resulted in hospitalization, an acute ECT course, and re-initiation of mood stabilizing medications. This case provides a framework for considering the role of ECT as a maintenance option for pregnant patients and emphasizes the need for further information on protocols for ECT treatment in the post-partum period.