Successful electroconvulsive therapy for postpartum psychosis intolerant to antipsychotic treatment

Abstract

Postpartum psychosis is a rare psychiatric syndrome that develops mood and psychotic symptoms, with an acute onset during the first 1-2 weeks after childbirth. One of the possible etiologies of postpartum psychosis is estrogen’s effect on the dopamine receptor function. Postpartum withdrawal of prepartum-increased endogenous estrogen may induce dopamine receptor supersensitivity. Treatment guidelines including pharmacotherapy have not yet been recommended; however, several case reports reported effectiveness of electroconvulsive therapy (ECT). We report a case of postpartum psychosis with grandiose delusions, auditory hallucinations, thought disorganization, mood instability, catatonia and consciousness disturbance; the patient was initially treated with atypical antipsychotics such as olanzapine and aripiprazole. She was intolerant to these medications and suffered severe extrapyramidal symptoms. ECT quickly relieved her psychotic and mood symptoms and she was discharged to outpatient follow-up.