To review literature related to continuing lithium during ECT in pregnant patients and report a case where this combination may have been warranted.
Manic episodes are common during pregnancy in women with bipolar I disorder. ECT is safe and effective in treating mania during pregnancy. Lithium is often discontinued during ECT for negative cognitive effects and due to risk of Ebstein’s anomaly during pregnancy. There may be cases when this combination would result in better outcomes and reduced risk to the fetus than alternative treatments.
Existing literature was reviewed through PubMed. We discuss a case of a 34-year-old female at 4 weeks gestation, previously stabilized on lithium, presenting with mania and catatonia who received ECT following treatment failure with antipsychotics and benzodiazepines.
Literature review yielded a case series suggesting safe use of lithium during ECT in non-pregnant patients. There was no literature reporting concomitant use of lithium and ECT in a pregnant patient. The patient in this case could not be treated with lithium during ECT due to institutional policies. She completed an acute ECT series on day 49 of her hospitalization, and lithium was restarted for maintenance.
Risk of undertreated mood episodes during pregnancy must be weighed against the risks of fetal exposure to psychiatric medications. This case suggests continuation of lithium during acute ECT series may be reasonable for a pregnant patient with mania complicated by catatonia. Additions to existing literature regarding concomitant use of lithium during ECT in a pregnant patient will further establish treatment guidelines.