Effectiveness of Electroconvulsive Therapy in Postpartum Psychosis: A Systematic Review

Abstract

Postpartum psychosis is a severe psychiatric condition that emerges shortly after childbirth. Electroconvulsive therapy provides rapid symptom relief, particularly in severe and treatment-resistant cases. Despite evidence supporting its effectiveness, the use of electroconvulsive therapy in postpartum psychosis remains limited and unstandardized. This systematic review evaluates the clinical effectiveness of electroconvulsive therapy in treating postpartum psychosis. A comprehensive search of PubMed/MEDLINE, Cochrane, SciELO, SCOPUS, and Web of Science identified 255 studies, of which 7 met the inclusion criteria. Electroconvulsive therapy was used exclusively in severe cases that did not respond to pharmacological treatment, leading to symptom improvement in all cases, with most achieving complete remission. The total number of electroconvulsive therapy sessions ranged from 5 to 15, with symptom improvement observed after 1 to 6 sessions and remission after 5 to 11 sessions. Reported side effects, including memory loss, mild cognitive deficits, and pain, were transient. These findings highlight the effectiveness of electroconvulsive therapy as a rapid and safe intervention for postpartum psychosis, particularly when pharmacological treatments are insufficient. However, small sample sizes and variability in treatment protocols limit the generalizability of results. Further prospective studies are needed to establish standardized guidelines and consider electroconvulsive therapy as a first-line treatment for postpartum psychosis.

Keywords: electroconvulsive therapy; electroconvulsive treatment; postpartum psychosis.