A 32-year-old woman at 16 weeks of gestation develops severe depressive stupor with mutism, negativism, refusal of food and fluids, and brief periods of psychomotor excitement. She refuses all oral medication. Her BMI has fallen sharply and she is medically deteriorating. What is the most appropriate treatment?
- A Wait until delivery, then initiate pharmacotherapy
- B Involuntary nasogastric feeding plus high-dose sertraline
- C Electroconvulsive therapy ✓
- D Chlorpromazine 600 mg/day orally
Correct answer: C. Electroconvulsive therapy
Explanation
Catatonic depression with refusal of food and fluids is a life-threatening emergency, and ECT is the treatment of choice because it acts rapidly, is highly effective for catatonia and psychotic depression, and has an excellent safety record in all trimesters of pregnancy with fetal monitoring. Waiting until delivery risks death from dehydration and malnutrition. Oral chlorpromazine cannot be given to a mute, uncooperative patient, and nasogastric feeding alone does not treat the underlying catatonic illness.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.