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J Affect Disord. 2018 Aug 1;235:258-264. doi: 10.1016/j.jad.2018.04.043. Epub 2018 Apr 9.

Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group.

Author information

1
School of Medical Sciences, University Health Care Research Centre, Örebro University, S-702 82 Örebro, Sweden.
2
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
3
Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden.
4
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
5
Faculty of Health Sciences, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden; Department of Psychiatry, Region Östergötland, Linköping, Sweden.
6
School of Medical Sciences, University Health Care Research Centre, Örebro University, S-702 82 Örebro, Sweden. Electronic address: axel.nordenskjold@regionorebrolan.se.

Abstract

INTRODUCTION:

Electroconvulsive therapy (ECT) is used to treat postpartum depression and psychosis based on clinical experience and small observational studies.

AIMS:

The primary aim was to test the hypothesis that the response rate to ECT for depression and psychosis is higher during the postpartum period than outside this period. The secondary aim was to identify predictors of a response to ECT during the postpartum period.

MATERIALS AND METHODS:

Cases with postpartum depression and/or psychosis received ECT within 6 months of delivery. A matched comparison group with depression and/or psychosis (not within the postpartum period) was identified from the Swedish National Quality Register for ECT. The improvement 1 week after ECT was classified according to the Clinical Global Impressions Scale - Improvement scale (CGI-I) as responder (CGI-I score 1-2) or non-responder (CGI-I score 3-7).

RESULTS:

185 cases and 185 comparison group subjects were included (46% with psychosis in each groups). More cases (87.0%) than comparison group subjects (73.5%) responded to ECT (p = 0.001). Adjusted binary regression analysis revealed that more severe symptoms prior to treatment were the only statistically significant predictor of response.

LIMITATIONS:

There was no control group without ECT treatment.

CONCLUSION:

The response rate of those with postpartum depression and/or psychosis to ECT was high. The response rate of patients with psychosis or depression was higher during the postpartum period than outside it. This study supports the use of ECT for severe forms of postpartum depression and/or psychosis.

KEYWORDS:

Electroconvulsive therapy treatment outcome; Postpartum depression; Postpartum psychosis; Puerperal disorders

PMID:
29660641
DOI:
10.1016/j.jad.2018.04.043
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