Small Businesses Rule! Please Keep Them Alive!

Shop Indie Bookstores

Wednesday, September 1, 2010

... do you mean like "One Flew Over The Cuckoo's Nest?"

As of late, I have had some very interesting conversations online with a woman named Mary who is 35-years-old, resides in Sydney, Australia... and is very anxious to start a family with her partner-in-crime. Her only deterrent...she is bipolar; the only mental and emotional solace that she has found is in a cocktail of antipsychotics, a popular anticonvulsant, and a seratonin reuptake inhibitor. She wrote to me with some interesting commentary about "Pendulum Pregnancy" and expressed her concern about medication, and the like.

Mary shared that "Working and living is taxing enough when dealing with this tempermental affliction. I commend you on your bravery for embarking on a journey into motherhood. I, too, want desperately to have a child, but my partner is a bit hesitant because of my mood instability. He fears that hormonally I will fall to pieces, and will not be able to be consistent as a mother if I stop taking my meds as doctors prescribe in the first trimester."

For Mary and everyone else with this concern, I'd like to share a few options that I have happened upon in my experience and research. I'd also like to take this opportunity to remind Mary that SHE knows what is best for her and should listen to her intuition. Don't you agree? Also, it takes two to tango; if her partner is quick to point the finger and "ass"ume that she "will not be consistent as a mother" if she stops taking her meds, perhaps he needs to reevaluate his thinking and remember that HE is the father... and the responsibility will rest on both of their shoulders. And if this is not an option for him... perhaps Mary needs to find another partner to share the experience with who appreciates her for her whims and inconsistencies that will make her an even more awesome mother. What do you think?

For Mary and those of you who are in a similar situation, I want to share some information about a very common procedure that many pregnant women undertake in lieu of medication for the first trimester and beyond if needed, called ECT (Electoconvulsive Therapy). I "tried" ECT after MUCH stalling, and discontinued it because I felt that it was not for me. I struggled through the first trimester as a result, and have been taking a very small dosage of fluoxetine since I was into my second trimester which has been an emotional saving grace. I think that the small dosage of the seratonin reuptake inhibitor combined with pregnancy hormones has cradled me through some rough swings.

Although, many women swear by ECT, and feel that it is THEIR saving grace during pregnancy complicated by mental illness... and beyond. Kitty Dukakis Wrote a book that helped to convince me to give it a try that
I highly recommend:

Although still seemingly ominous, ECT has evolved from the archaic days and shock treatment reminiscent of "One Flew over the Cuckoo's Nest." I'd like to share and article published in January of 2008, followed by sources for your perusal:
"Electroconvulsive therapy (ECT) is one of the most effective treatments for depression, with response rates that are consistently higher than those observed in clinical trials of antidepressants. Furthermore, ECT may be more effective than medications for treatment-refractory depression. The American Psychiatric Association (APA) recommends ECT for patients who have had previous positive response to ECT or who are non-responsive to pharmacological treatments, as well as for those patients who experience severe psychiatric symptoms, including depression with psychosis. suicidal ideation, and mania.

ECT has also been shown to be relatively safe during pregnancy and may offer some advantages over antidepressants in minimizing exposure to psychotropic medications during pregnancy. (Kasar et al 2007, Miller 1994, Repke and Berger 1984). Extra precautions have been suggested for ECT treatment in pregnant patients, including the addition of an obstetrician to the psychiatrist and anesthesiologist team. Before ECT, a pelvic examination should be performed on the patient to check for vaginal bleeding or cervical dilation. Because pregnancy increases the risk of gastric regurgitation and pulmonary aspiration during ECT, some anesthesiologists prefer to intubate the patient after the first trimester in order to maintain a clear airway. Additionally, a pregnant patient should be kept well-hydrated throughout the ECT procedure. A fetal heart monitor is often used, and oxygen administration adjusted accordingly. (Miller 1994, Walker and Swartz, 1994).

Overall the risk to the fetus is low. In a meta-analysis of 300 cases of ECT use during pregnancy (Miller 1994), four cases of premature labor (1.3%) were reported. In all cases, the clinician determined that the premature labor was not related to the ECT. The miscarriage rate for women receiving ECT during pregnancy (1.6% of cases) was not significantly higher than the rate of miscarriage in the general population. Two cases (0.6%) reported uterine contractions directly after ECT, but neither resulted in any significant consequences to either the mother or fetus. Recent case studies of ECT treatment and premature delivery have underscored the need for close monitoring of the mother and fetus but have not lead clinicians to conclude that ECT increases the risk of premature delivery (Kasar et al, 2007). Typically if a patient develops uterine contractions or any signs of preterm labor during or after ECT, treatment with ECT is postponed.

Despite evidence that electroconvulsive therapy (ECT) is a safe and effective treatment for many psychiatric illnesses during pregnancy, many clinicians and patients are still reluctant to pursue this option, concerned that it will harm the fetus or incur extra risk for the patient. Ultimately, the clinician must weigh the risks to both mother and fetus involved in not treating a woman who suffers from severe psychiatric symptoms against the risks involved in ECT treatment, and facilitate the most appropriate clinical intervention for the individual patient."

Erica Pasciullo, BA

Kasar M, Saatcioglu O, Kutlar T. Electroconvulsive therapy use in pregnancy. J ECT. 2007 Sep;23(3):183-4.

Miller LJ. Use of electroconvulsive therapy during pregnancy. Hosp Community Psychiatry. 1994 May;45(5):444-50.

Repke JT, Berger NG. Electroconvulsive therapy in pregnancy. Obstet Gynecol. 1984 Mar;63(3 Suppl):39S-41S.

Walker R, Swartz CM. Electroconvulsive therapy during high-risk pregnancy. Gen Hosp Psychiatry. 1994 Sep;16(5):348-53.

Other ECT Resources:

Massachusetts General Hospital Somatic Therapies Unit

American Psychiatric Associatiton Information on ECT

Shock: The Healing Power of Electroconvulsive Therapy by Kitty Dukakis and Larry Tye. Kitty Dukakis is the wife of former Governor of Massachusetts Michael Dukakis. She spoke recently at Mass General Hospital Psychiatry Grand Rounds about her experience as an ECT patient and advocate.

...till next time - Amanda xo

p.s. Has Ana undergone shock treatment as of late?

No comments:

Post a Comment