Somatic treatments in perinatal psychiatry

Abstract

Pharmacotherapy in pregnancy is associated with complications including teratogenic effects, perinatal syndromes, etc. In the postnatal period, there is a risk to the newborn through breast feeding. We need to treat major psychiatric disorders in pregnancy and post natal period using the risk-benefit paradigm. This is easier done if safer treatment than pharmacotherapy is available. Somatic therapy could be one such option. Electroconvulsive therapy (ECT) has been practised for years in general psychiatry. Use in pregnancy has been restrictive. Use of ECT in such cases will be discussed. Newer treatments available include repetitive Transcranial Magnetic Stimulation (rTMS) and Vagal Nerve Stimulation (VNS). rTMS has been tested in depression using randomised controlled trials in general and old age psychiatry. Its use in pregnancy will be discussed. Though VNS is not as well researched as rTMS, its use in general psychiatry and more specifically in perinatal psychiatry will be discussed.