From the FDA Drug Label
When treating pregnant women with fibromyalgia are at increased risk for adverse maternal and infant outcomes including preterm premature rupture of membranes, preterm birth, small for gestational age, intrauterine growth restriction, placental disruption, and venous thrombosis. Women who discontinue antidepressants during pregnancy are more likely to experience a relapse of major depression than women who continue antidepressants The FDA drug label does not answer the question.
From the Research
Electroconvulsive therapy (ECT) is considered when medication and psychotherapy are insufficient for treating severe depression in pregnant women. ECT involves brief electrical stimulation of the brain while the patient is under anesthesia and is typically administered 2-3 times weekly for 6-12 treatments, though the exact number depends on clinical response. This intervention is particularly valuable during pregnancy because it avoids potential medication-related teratogenic risks while effectively addressing severe depression, especially when there are acute suicidal thoughts or psychotic features. Some key points to consider when using ECT in pregnant women include:
- ECT has a long safety record in pregnancy with minimal risks to the fetus when proper precautions are taken, including fetal monitoring, maternal positioning to prevent aortocaval compression, and careful anesthesia management 1.
- The procedure works by inducing changes in neurotransmitters and promoting neuroplasticity, often providing faster symptom relief than medications.
- While side effects may include temporary memory issues and confusion, these are generally manageable and must be weighed against the significant risks that untreated severe depression poses to both mother and developing child.
- A systematic review and meta-analysis found that an adjuvant antidepressant enhances the efficacy of electroconvulsive therapy for major depression, with tricyclic antidepressants, selective serotonin reuptake inhibitors/serotonin noradrenaline reuptake inhibitors, and monoamine oxidase inhibitors showing the same effect size 1.
- The optimal dose of selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine in major depression has been studied, with results indicating that the lower range of the licensed dose achieves the optimal balance between efficacy, tolerability, and acceptability in the acute treatment of major depression 2. However, the use of ECT in pregnant women should be carefully considered on a case-by-case basis, taking into account the individual patient's needs and medical history.