The Effectiveness of Electroconvulsive Therapy in Comparison to Pharmacological Treatment in Pregnant Women Diagnosed with Major Depression - Literature review Example

The Effectiveness of ECT in Comparison To Pharmacological Treatment in Pregnant Women Diagnosed with Major Depression Name: Course: Institution: Date: The Effectiveness of ECT in Comparison to Pharmacological Treatment in Pregnant Women Diagnosed with Major Depression Introduction Illnesses of pregnant women are treated with care because both pharmacological treatment and the sicknesses of the mother can affect the health of the foetus and have varying benefits and risks to the health of the mother. More than a third of pregnant women experience depression in the early stages of the pregnancy. According to Saatcioglu et al (2011), Electroconvulsive Therapy and pharmacological treatment are the two medications that have been used for a while. Each of the two methods has its effects on the mother and the foetus and this literature review is a comparison of the effectiveness of the treatment. This research paper looks into the effectiveness of ECT in treating pregnant women that have major depression in comparison to using pharmacological therapy. It analyses the two methods depending on work done by other authors. It also compares the advantages, disadvantages, main issues; points of controversy, methodologies involved in fact finding and limitations that have not been assessed by previous authors. In addition it considers the applicability of the paper and points out other research aspects on ECT. This literature review is the outline of the critique of other articles. Critique of articles Main Themes According to Leiknes et al (2013), Electroconvulsive therapy is mainly used in cases of pregnant women that are highly suicidal, resistant to pharmacological antidepressant treatment, have psychotic agitation and have low physical health due to dehydration and malnutrition. It is most suitable for pregnant women that are unresponsive to many trials of treatment using antidepressants. Electroconvulsive therapy has been noted to be effective in the three trimesters of pregnancy and it had no risks on the health of the mother and child. However, safe monitoring of the baby and mother should be done so s to handle any complications. Due to this, it is one of the safest and fastest methods of treating major depression. According to Galbally et al (2014), a follow up on the health of 30 up to six year old children whose mothers underwent Electroconvulsive Therapy during pregnancy shows no abnormalities in the development of the children. Antidepressants are also used in treating depression but they are reported to have some negative effects on the foetus and the mother. This may happen during the pregnancy and postpartum. There are varied antidepressant treatments that are given out during pregnancy and postpartum and examples include Selective Serotonin Reuptake Inhibitors, tricyclic antidepressants and serotonin norepinephrine reuptake inhibitor. The main harms that are caused by pharmacological treatment on the infant are congenital anomalies, pulmonary hypertension, respiratory complications, neo natal convulsions, all cause mortality and heart defects. In the pregnant mother, antidepressants are likely to lead to death through suicide in cases of major depression, all-cause mortality and death by specific causes and other adverse effects such as seizures, hepatotoxicity, gastrointestinal complications, hypernatremia, toxicity, foetal development abnormalities and activation of hypomania. The development of these effects is highly dependent on the antidepressant administered and the health of the mother. In the report by Saatcioglu et al (2011), highlights different antidepressants used on pregnant women for example benzodiazepines and some mood stabilisers may have teratogenic risks for women in their first trimester of pregnancy. In the later stages, the antipsychotics may cause motor abnormalities while benzodiazepines sometimes cause apnea, temperature deregulation and hypotomia. Methodologies The method that has been used in this literature report is the study and analysis of related journal articles that were written in the period 2007-2014. The research paper by Bulbul et al (2013) included a research conducted on 33 pregnant patients who were administered with Electroconvulsive therapy and had psychiatric disorders. The research paper by Gentile et al (2011) was a report whose methodology was a systematic analysis of literature reviews on pharmacological treatment and ECT on pregnant depressed women that were done in the period 1973 to 2010. In the report by Nielsen et al (2012), a literature review carried out in Pubmed on the effect of Selective Serotonin Reuptake inhibitors, SNRI and antidepressants on pregnant women. The report by Wisner et al (2009) uses a decision making model that is assessed by psychiatrists to come up with an effective method of treating major depression in women that are pregnant. In the report by Anderson et al (2009), the methodology involved analysis of information from articles on the effect of electroconvulsive therapy. They considered 339 cases that have been done since 1941 till 2007. In the report by Saatcioglu et al (2011), the Collaborative Perinatal Project is analysed. A research was carried out over a period and involved analysis of effects of antidepressants on pregnant women. In the project, 4 women were administered with glycopyrrolate and 401 were given atropine. The aim of the study was to analyse the effect of the two drugs that are part of the ECT administration process on the pregnancy. Additionally, the author analyses major effects of the antidepressants after analysis of articles on the topic. Findings and Validity of findings The main finding from the report by Gentile et al (2011) which involved a systematic analysis of previous reports concludes that the antidepressant pharmacological treatment does not have an effect on the neurodevelopment of the children and infant after birth. Therefore, pharmacological treatment, in their study, did not have effects on the health of the children. The main findings of Saatcioglu (2011) report are: administration of pharmacological antidepressant treatment in pregnancy in the first trimester may lead to congenital abnormalities; ECT is safer when treating depression in the first trimester of the pregnancy, ECT is recommended when pharmacological treatment has failed in treating the depression and when the patient has had a successful ECT treatment before. In the later stages of the pregnancy, administration of Electroconvulsive Therapy will require close monitoring of the mother and the foetus and care should be taken as risk of regurgitation is increased. They conclude that from the analysis, ECT is effective in treating major depression and should be done in facilities that can handle pregnancy-associated emergencies. Therefore, Gentile et al(2011) pharmacological treatment has no effect on the development of the child and on the mother but Saatcioglu (2011) concludes that ECT is more effective in treating depression in pregnant women. The study by Bulbul et al (2013), all 33 cases of pregnant women with concurrent psychiatric disorders who were treated by ECT were successful and led to birth of the infants without any risks. In the report by Nielsen et al (2012), SSRI treatment is associated with the risk of low birth weight. Tricyclic antidepressants are concluded to be safe but may increase the risk to malfunctions, decreased birth weight and increased risk to preterm births. After birth, the babies might develop irritability syndrome that whose characteristics include constipation, convulsion, urine retention, poor feeding and crying. Serotonin noradrenergic reuptake inhibitors are safe without risks of any malfunctions. In the report, it is noted that ECT is safe to be in all trimesters of pregnancy and post-partum. It is recommended that it be done after careful physical tests to reduce cases of complications during the ECT procedures. Therefore, Bulbul et al (2013) concludes that ECT is effective in treating depression in pregnant women while Nielsen et al (2012) concludes that pharmacological depression treatment may have several risks. He highlights that ECT is more rapid in treating depression amd has no risks compared to ECT. Therefore, ECT was safe in treating the psychiatric disorders during pregnancy without affecting the term of the pregnancy. In the study by Anderson et al (2009), out of the 339 patients that were treated using ECT, 78% was successful. There were 25 fetal complications, 11 of which were related to ECT. There were two deaths among the 11. Additionally, it was reported that there were 20 maternal complications and 18 of them were related to ECT. The report highlights some risks that ECT has which include fetal bradyarrhythmias, adverse effects such as temporary memory loss, preterm births and the effects presented by the aesthetic elements that are part of the ECT treatment. The main finding from the study done by Wisner et al (2009), shows that pharmacological treatment of depression does not affect the weight of the mother or infant after birth but may lead to preterm births. Therefore, Wisner et al (2009) concludes that the only effect that pharmacological treatment has is the fact that it may lead to preterm births but Anderson et al (2009) concludes that it is safe to use ECT but it may have some risks such as preterm births and temporary memory loss. During the administration of ECT, several procedural drugs are administered. These include anaesthetics, muscle relaxants and anticholinergic. The drugs that are administered may have effects on the pregnancy. According to Saatcioglu et al (2011), the use of atropine which is an anticholinergic affected 4% of the infants as they were born with malfunctions. Some muscle relaxants such as Succinylcholine led to prolonged apnea in mothers that underwent caesarean section during delivery. It however does not affect the foetus because it does not pass through the placenta in high amounts. Most anaesthetics will have no effect on the foetus although they may cause reduction in the foetal heart rate. These additional procedural medications do not have effects on the foetus. Main Findings Pharmacological treatment of major depression in pregnancy may affect the mother by increasing her risk preterm births that is induced by pregnancy. In some cases, as concluded by Wisner et al (2009) it may lead to foetal respiratory problems and preterm births. As stated by Saatcioglu et al (2011), electroconvulsive therapy has been used over a period of more than fifty years and is effective especially in cases of pregnant women that are unresponsive to antidepressants. In addition to that, it reduces the worries of risks presented by pharmacological treatment such as preterm births. Most of the authors that studied the effectiveness of ECT note that it is safe and effective but should be administered with caution. The most important factor is that ECT should be administered in facilities that can handle any pregnancy related emergencies. Generally, ECT seems more effective than pharmacological treatment. Applicability This literature review has been a study of several varied authors. The study populations that they have used are not necessarily pregnant women with major depression. In some cases they are a study of general effects of pharmacological depression treatment in women that are pregnant but not diagnosed with major depression. The applicability of the findings may not totally relate to women that have major depression but this does not mean that the findings are irrelevant. The most applicable article reviewed is the study by Bulbul et al (2013) that involved the consecutive treatment of pregnant women with depression using ECT. It proved that ECT was safe. This is most applicable article in this to the review. The effects of pharmacological treatment are the same for pregnant women, with or without depression. In addition to that, some of the articles that were limited to pregnant women that were depressed did not define the levels of the depression as major or mild. These findings can be applied to current practise through ensuring that patients are well monitored during the ECT treatment. Counselling on both ECT and pharmacological treatment risks and benefits should also be well explained to patients before they are treated. Since depression occurs in more than 14% of pregnant women, both ECT and pharmacological methods can be used with consideration of the mother’s health and trimester of pregnancy. Limitations and Research Gaps The limitations that are noted in most of the articles on ECT and pharmacological treatment are the small number of sample used in studies where there is administration of ECT. In some of the cases that have been reviewed the numbers of patients that have been used in the study are not specified. This may put doubts on the findings presented by the articles and other literature reviews. In addition to that, it is not stated in the cases that we have used in this literature review whether the patients that were used in case studies were patients of major depression, minor depression or were resistant to pharmacological treatment. It is only stated that they were pregnant and depressed. Future studies should also be done on the rate of relapsing that occurs in patients that have been treated by ECT before. The prognostic factors about the pregnant women that are used as study population are not known. These include depression history, depression treatment history, other illnesses, age, economic status, health conditions and other social factors such as alcoholism, drug abuse. Future research should eradicate these limitations. Further research Electroconvulsive therapy has been confirmed to be safe and fast in handling cases of major depression. More research should be done on the efficacy of the method and its long term effects as well as cases of relapse. In most articles, future development of the mother and child after electroconvulsive therapy has not been mentioned but it is reported that healthy births were done. Therefore, further research should cover the post-partum development after the treatment. Additionally, anaesthetics are administered during the process and the effects and risks that it presents to the foetus and the mother should be researched. It is also important to research into the statistical number of physicians that are trained on the administration of ECT to understand the need for trained psychotherapists in present society after comparing cases of depression in women. Conclusion From the literature reviews discussed in this paper it is clear that pharmacological treatment of depression in pregnant women may have effects on the mother which include an increased risk to hypertension and preterm births after consumption of SNRIs and SSRIs. This may lead to complications during birth and pregnancy because the foetus also absorbs the antipsychotics administered. On the other hand, non-pharmacological methods such as Electroconvulsive therapy are safe and effective but present minor risks. It is however recommended that Electroconvulsive therapy is administered when the baby’s and mother’s health are closely monitored and be carried out in hospitals that can handle preterm births and any maternal complications that may arise. Since the uses of pharmacological methods are not highly advised during pregnancy, Electroconvulsive therapy is the second option and is a very effective method of treating major depression. References Anderson, E. L., & Reti, I. M. (2009). ECT in pregnancy: A review of the literature from 1941 to 2007. Psychosomatic Medicine, 71(2), 235-242 Bulbul, F., Copoglu, U., Alpak, G., Unal, A., Demir, B., Tastan, M., & Savas, H. (2013), Electroconvulsive therapy in pregnant patients, General Hospital Psychiatry, 35(6), 636-639. Gentile, S., & Galbally, M. (2011). Prenatal exposure to antidepressant medications and neurodevelopmental outcomes: a systematic review. Journal of affective disorders, 128(1), 1-9. Nielsen, R., & Damkier, P. (2012). Pharmacological treatment of unipolar depression during pregnancy and breast-feeding-A clinical overview. Nordic Journal of Psychiatry, 66(3), 159-166 Saatcioglu, O. & Tomruk, N. B. (2011). The use of electroconvulsive therapy in pregnancy: a review. Israel Journal of Psychiatry and Related Sciences, 48(1), 6. Retrieved 23rd Oct, 2014 from< http://doctorsonly.co.il/wp-content/uploads/2011/12/2011_1.1_2.pdf> Wisner, K., Sit, D., Hanusa, B., Moses-Kolko, E., Bogen, D., Hunker, D., & Singer, L. (2009). Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. American Journal of Psychiatry, 166(5), 557-566. Read More