to most psychiatric medications has also contributed to its use for postpartum psychosis for over 50 years; however, to date, data has been limited to a significant number of case series and various retrospective matched-cohort studies. Thus, while there is a strong suggestion that ECT is an efficacious treatment for post-partum psychosis, future research is needed to fully validate its role in management. There are few adverse effects associated with ECT, though reports of short-term memory disturbance (< 6 months) have been reported. ECT has been seen as preferable for some who are adverse to the use of long-term psychiatric medications, particularly given the minimal and short-term impact that ECT-related medications (e.g., drugs for muscle relaxation and anesthesia) appear to have on breastfeeding (as compared to psychiatric medications). Per current recommendations, ECT is considered an option for PPP when medications are ineffective. Lithium Lithium is a psychiatric medication commonly classified as a "mood stabilizer" and often used for the treatment of bipolar disorder. For PPP, lithium can be administered as a medication by itself ("monotherapy") or as an additional medication with other psychiatric drugs ("adjunctive therapy"). Research has shown strong evidence for its effectiveness as monotherapy in preventing repeat episodes of psychosis, particularly when compared to antipsychotic use alone, and current recommendations suggest that it is used first in treating PPP for patients who are able to safely (lithium is not advised for patients with severe kidney or heart disease, thyroid dysfunction, Brugada syndrome, or who have known allergies to the drug). Lithium has been associated with side effects to the fetus when taken during pregnancy, including body and heart abnormalities (e.g., Ebstein's anomaly); these effects have been documented in all trimesters, but higher risks, particularly for structural heart problems and spontaneous abortion, are typically seen with exposure in the first trimester. Lithium is also currently the recommended medication for prevention of psychotic episodes in individuals who have a known history of bipolar disorder and/or previous episodes of PPP. The preferred strategy for preventative medication is to begin lithium immediately following delivery of the infant, minimizing the exposure of the fetus to lithium while in the womb. Treatment throughout pregnancy, however, may be warranted as appropriate for treatment of bipolar disorder, and is dosed according to appropriate medical advisory for the patient's trimester. Lithium effectiveness is based on reaching an optimum level in the individual's blood, which usually requires more