Which of the following medications may be administered before electroconvulsive therapy? Select all that apply.

Cognitive behavioral therapy (CBT) is a structured, evidence-based psychotherapeutic approach that targets maladaptive thoughts, emotional distress, and behavioral patterns. It is especially effective in treating depression, including during pregnancy, where pharmacologic options may be limited due to fetal safety concerns. CBT helps clients identify and reframe negative thought processes, develop coping strategies, and improve mood through behavioral activation and cognitive restructuring.

Rationale for correct answer

4. CBT is the most widely recommended nonpharmacologic treatment for depression in pregnancy. It is safe, effective, and adaptable to individual needs. CBT addresses distorted thinking and promotes behavioral engagement, making it ideal for clients who are reluctant to use medications during gestation.

Rationale for incorrect answers

1. Client-centered therapy emphasizes unconditional positive regard and empathy but lacks the structured cognitive and behavioral techniques necessary for targeted depression treatment. It may support emotional expression but is less effective in modifying depressive thought patterns.

2. Gestalt therapy focuses on awareness and present-moment experience, often using experiential techniques. It is not first-line for depression and lacks the empirical support and structured framework that CBT provides, especially in perinatal populations.

3. Therapeutic touch therapy is based on energy field manipulation and lacks robust scientific validation. It is not considered an evidence-based intervention for depression and should not be recommended as a primary treatment modality.

Take Home Points

• CBT is the most effective and evidence-based nonpharmacologic therapy for depression during pregnancy.
• It targets cognitive distortions and promotes behavioral activation, improving mood and functioning.
• Other therapies may offer emotional support but lack the structured approach and empirical backing of CBT.
• Safety and efficacy are critical when selecting treatments for pregnant clients with mood disorders.

Electroconvulsive therapy (ECT) induces a controlled seizure to treat severe psychiatric conditions such as major depression, catatonia, and psychosis. The procedure causes transient increases in cerebral blood flow and metabolic demand, which can elevate intracranial pressure. While many medical conditions are considered relative contraindications, increased intracranial pressure (ICP) remains the only absolute contraindication due to the risk of cerebral herniation and irreversible brain damage.

Rationale for correct answer

1. Elevated intracranial pressure is the only absolute contraindication for ECT. The seizure-induced surge in cerebral perfusion and oxygen demand can dangerously exacerbate ICP, risking brainstem compression and herniation. This makes ECT unsafe until ICP is stabilized or resolved.

Rationale for incorrect answers

2. A recent myocardial infarction is a relative contraindication. ECT causes transient sympathetic stimulation, which may strain cardiac function, but with proper monitoring and stabilization, it can be safely administered in select cases.

3. Severe hypertension increases cardiovascular risk during ECT but is not absolute. Pre-treatment antihypertensive management and intra-procedural monitoring allow safe administration in many hypertensive clients.

4. Congestive heart failure poses hemodynamic concerns due to fluid overload and reduced cardiac output. However, it is a relative contraindication, and ECT may still be used with cardiac clearance and close monitoring.

Take Home Points

• Increased intracranial pressure is the only absolute contraindication for ECT due to risk of herniation.
• Cardiac conditions like MI and CHF are relative contraindications requiring individualized risk assessment.
• ECT elevates cerebral blood flow and metabolic demand, making ICP management critical.
• Most medical conditions can be managed to allow safe ECT with proper precautions.