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Practice Practice Pointer

Assessing low mood during pregnancy

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4584 (Published 29 July 2019) Cite this as: BMJ 2019;366:l4584

Rapid Response:

ECT dangers in pregnancy Re: Assessing low mood during pregnancy

Is any ECT is unacceptable in pregnancy?

A 2003 UK ECT Review Group concluded that ECT is an effective short-term treatment for depression.[1] In contrast, a 2015 systematic review by Leikenes and colleagues of the effects on the child recommended an urgent update of international guidelines.[2]

The Leikenes case studies involved 69 pregnant women who were given a mean number of 9.4 ECTs, at a mean age of 29 years. Most women received ECT during the 2nd trimester and many were primigravida. Main diagnostic indication in the years 1970 to 2013 was depression/bipolar disorder (including psychotic depression). Missing data on foetus/child was 12%. ECT parameter report was often sparse. Both bilateral and unilateral electrode placement was used and thiopental was the main anaesthetic agent. Adverse events such as foetal heart rate reduction, uterine contractions, and premature labour (29 to 37 weeks gestation) occurred in nearly one third (29%). The overall child mortality was 7.1% overall. Lethal outcomes for the foetus and/or baby had diverse associations. They advised that ECT during pregnancy is should only be considered as last resort treatment under very stringent diagnostic and clinical indications

There is also evidence linking antidepressant medications with increases in autism. Of 3342 children exposed to antidepressants during pregnancy, 4.1% (n=136) had a diagnosis of autism compared with a 2.9% prevalence (n=353) in 12 325 children not exposed to antidepressants whose mothers had a history of a psychiatric disorder (adjusted odds ratio 1.45, 95% confidence interval 1.13 to 1.85). [3]

Zinc, magnesium, B vitamins and omega-3 and omega-6 polyunsaturated fatty acids levels are commonly deficient in depression. In 1988 we found that dyslexic children were zinc deficient and low maternal zinc in early pregnancy may adversely affect the development of stress coping mechanisms. [4] THINK ZINC! Monitored repletion of deficiencies is vital for the physical and mental health of both mother and child both before and during pregnancy and lactation. [5]

It is alarming that psychiatrists would choose to give depressed pregnant women potentially dangerous antidepressants or electroconvulsive therapy (ECT) rather than investigate and correct very common essential nutrient deficiencies.

1 UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003 Mar 8;361(9360):799-808.
2 Leikenes KA Cooke MJ, von Schweder J, Harboe I, Hoie B. Electroconvulsive therapy during pregnancy: a systematic review of case studies. Arch Womens Ment Health. 2015; 18: 1–39.
3 Rai D, Lee B K, et al. Antidepressants during pregnancy and autism in offspring: population based cohort study. BMJ 2017;358:j2811.
4 Grant ECG, Howard JM, et al. Zinc deficiency in children with dyslexia: concentrations of zinc and other minerals in sweat and hair. BMJ 1989;296:607-609.
5 Barnes B, Grant ECG et al. Nutrition and preconception care. Lancet 1985;2:1297.

Competing interests: No competing interests

16 August 2019
Ellen C G Grant
Physician and medical gynaecologist
Retired
Kingston-upon-Thames. UK