A 30-year-old woman at 12 weeks of gestation has severe major depression with refusal to eat, 6 kg weight loss, dehydration, and passive suicidal ideation. She has failed an adequate trial of sertraline with intolerable side effects. Which intervention is both safe in pregnancy and appropriate here?
- A Electroconvulsive therapy ✓
- B Switch to paroxetine
- C Start sodium valproate augmentation
- D Withhold all treatment until delivery
Correct answer: A. Electroconvulsive therapy
Explanation
ECT is safe in all trimesters of pregnancy and is the treatment of choice for severe, life-threatening depression in pregnancy, especially with refusal to eat, dehydration, suicidality, or failure of drug therapy; muscle relaxants and brief anaesthesia make uterine contractions rare. Paroxetine is specifically associated with cardiac malformation concerns in early gestation, valproate is highly teratogenic, and withholding treatment risks maternal and fetal harm from starvation, weight loss, and possible suicide.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.