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Case Reports
. 2025 Mar;29(1):48-50.
doi: 10.1080/13651501.2025.2472676. Epub 2025 Mar 14.

Electroconvulsive therapy in depression with twin pregnancy

Lucie Joly  1   2 , Hugo Bottemanne  2   3 , Marie-Pierre Bonnet  4   5 , Anne Pinton  6 , Vladimir Adrien  1 , Stephane Mouchabac  1   2 , Florian Ferreri  1   2
Affiliations
Case Reports

Electroconvulsive therapy in depression with twin pregnancy

Lucie Joly et al. Int J Psychiatry Clin Pract. 2025 Mar.

Abstract

The use of electroconvulsive therapy (ECT) during twin pregnancy has been insufficiently studied, and there is limited evidence regarding its safety. Here, we present a case of successful use of ECT for severe major depressive disorder during twin pregnancy. The patient suffers from psychotic depression with catatonic presentation and Cotard syndrome (delusions with denial of internal organs). This case illustrates the difficulty in managing severe antenatal depression and addresses the guidelines for the ECT protocol (anaesthetic modalities, obstetrical monitoring, and duration of treatment) during twin pregnancy.

Keywords: ECT; Perinatal psychiatry; electroconvulsive therapy; perinatal depression; pregnancy; twin pregnancy.

Plain language summary

The use of electroconvulsive therapy (ECT) for severe or treatment-resistant major depressive disorder during a twin pregnancy is a valuable and well-tolerated therapeutic option.Obstetric monitoring is recommended during each ECT session, including a pelvic examination, monitoring of vaginal bleeding, ultrasound assessment of foetal well-being (manning) and cardiotocography.The decision to use ECT during pregnancy is based on a careful evaluation of the benefit–risk balance, and twin pregnancy is not a contraindication.

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