CHENNAI: Government Institute of Mental Health (IMH) in Kilpauk, for the first time in its more than two centuries of existence, administered modified Electroconvulsive Therapy (m-ECT) to a pregnant woman, a 30-year-old diagnosed with Bipolar Affective Disorder*.
The therapy is a biological treatment procedure entailing a brief application of electrical stimulation under anaesthesia to produce a generalised seizure.
Kala** was first brought to the IMH out-patient unit on September 15, 2021, with aggressive behaviour. "She was four months pregnant then and was a danger to herself and the baby," said Dr M Geetha, assistant professor at IMH.
She was discharged after five days with a prescription for psychiatric drugs but relapsed as she was not taking the medicines properly. She was admitted to the hospital on October 10, 2021. "She was exhibiting suicidal tendencies and was uncontrollable. She didn't even realise she was pregnant," said Dr Geetha.
It was then that Dr V Venkatesh Mathankumar, professor of IMH, and his team decided to administer m- ECT to her. "There are studies that suggest ECT is safe for pregnant women. Since the patient's condition didn't improve with psychiatric drugs, we decided to give her ECT (shock therapy in common parlance)," said Ventakesh Mathankumar.
They invited two anaesthesiologists from Rajiv Gandhi Government General Hospital and obstetrics and gynaecologists from Government Hospital for Women and Children. After the gynaecologists and others evaluated the patient, the procedure began on October 20.
All vitals of the patient were checked before the therapy began and a gynaecologist monitored the fetal heart rate and blood circulation through Doppler ultrasound during the procedure, Venkatesh Mathankumar said. Subsequent cycles were administered only after ensuring that the mother and the baby were safe. (Doctors normally give patients six cycles of ECT).
There is a lot of misunderstanding about ECT because of how it was shown in movies. "When we talk about ECT, people would ask why do we want to give an electrical shock to a patient. We would then explain to them that it's not done as shown in the movies," said Dr P Poorna Chandrika, IMH director.
M-ECT is a scientific procedure in which the patient will have just abnormal movement of the thumb, unlike in direct ECT, wherein patients would get seizures, said Dr Poorna Chandrika.
She said IMH administered direct ECT (without anaesthesia) till 2010, after which it was slowly phased out. Now, only m- ECT, which is considered more humane and minimises complications, is administered. "It's just like any other surgical procedure," the doctor added.
On March 2 this year, Kala gave birth to a healthy baby girl by Caesarean section at Government Hospital for Women and Children in Egmore and is doing fine. She is on psychiatric drugs, said Dr Venkatesh Mathankumar.
*Bipolar Affective Disorder is a disorder associated with episodes of mood swings
**Name changed