Successful Treatment of Major Depression with Electroconvulsive Therapy in a Pregnant Patient with Previous Non-Response to Prefrontal rTMS

Abstract

The treatment of psychiatric disorders during pregnancy poses a challenge particularly regarding limited pharmacological possibilities. Repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) have been described to be successful in single cases, however, guidelines are lacking. In order to contribute to the pool of empirical data that is necessary to create evidenced-based recommendations we present a case of successful treatment of major depression with ECT in a pregnant patient with previous non-response to rTMS.

Key words

electroconvulsive therapy (ECT) - pregnancy and lactation - repetitive transcranial magnetic stimulation (rTMS) - antidepressants - depression treatment

• References

• 1 Zhang D, Hu Z. RTMS may be a good choice for pregnant women with depression. Arch Women Ment Health 2009; 12: 189-190
• 2 Klirova M, Novak T, Kopecek M et al. Repetitive transcranial magnetic stimulation (rTMS) in major depressive disorder during pregnancy. Neuro Endocrin Lett 2008; 29: 69-70
• 3 Nahas Z, Bohning D, Molloy M et al. Safety and feasibility of repetitive transcranial magnetic stimulation in the treatment of anxious depression in pregnancy: a case report. J Clin Psychiatry 1999; 60: 50-52
• 4 Anderson E, Reti I. ECT in pregnagncy: a review of the literature from 1941 to 2007. Psychosomatic Med 2009; 71: 235-242
• 5 American Psychiatric Association . The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging: a task force report of the American Psychiatric Association. 2^nd edition Washington, DC: American Psychiatric Press; 2001
• 6 Chambers C, Hernandez-Diaz S, Van Marter L et al. Selective serotonin-reuptake inhibitos and risk of persitent pulmonary hypertension of the newborn. N Engl J Med 2006; 9: 579-587
• 7 Alwan S, Friedman J. Safety of selective serotonine reuptake inhibitos in pregnancy. CNS Drugs 2009; 23: 493-509
• 8 APA . Diagnostic and statistical manual of mental disorders. 4^th ed. Washington, DC: American Psychiatric Association; 2000
• 9 Herwig U, Padberg F, Unger J et al. Transcranial magnetic stimulation in therapy studies: examination of the reliability of "standard" coil positioning by neuronavigation. Biol Psychiatry 2001; 50: 58-61
• 10 Hautzinger M, Keller F, Kühner C. BDI-II. Beck-Depressions-Inventar. Revision. 2. Auflage. Pearson Assessment; Frankfurt: 2009
• 11 Herwig U, Fallgatter A, Höppner J et al. Antidepressant effects of augmentative transcranial magnetic stimulation: randomised multicentre trial. Br J Psychiatry 2007; 191: 441-448