Ana Ganho-Ávila1, Anna Poleszczyk2, Mahmoud M A Mohamed3, Ana Osório4. 1. Faculty of Psychology and Educational Sciences, University of Coimbra, 3001-802 Coimbra, Portugal; Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Rua do Colégio Novo, 3001-802 Coimbra, Portugal. Electronic address: ganhoavila@fpce.uc.pt. 2. Department of Clinical Neuropshysiology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland. 3. Deutsches Forschungszentrum für Künstliche Intelligenz (DFKI GmbH), 10559 Berlin, Germany. 4. Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, 01302-907 São Paulo, Brazil.
Abstract
BACKGROUND: Repetitive Transcranial Magnetic Stimulation (rTMS) has been suggested as an alternative treatment to postnatal depression (PPD). OBJECTIVES: This systematic review aims to examine and summarise evidence on rTMS efficacy in treating depression during the postnatal period. METHODS: We included randomized and non-randomized, single arm, and case report studies, with active rTMS and theta-burst stimulation, sham rTMS, pharmacotherapy or no treatment as comparators. Participants included women with PPD, who were administered rTMS after delivery and up to 12 months postpartum. The observed outcomes were response rate and acceptability. RESULTS: rTMS shows promising results, with clinically significant decreases in Edinburgh Postnatal Depression Scale (EPDS) scores at week 4 and an overall low risk of dropout. LIMITATIONS: The reduced number of reports, the lack of complete datasets and the serious/high risk of bias of the studies warrant cautious interpretations. CONCLUSIONS AND IMPLICATIONS: Despite the promising results, existing evidence on rTMS efficacy is limited, and questions remain on what the most beneficial stimulation parameters should be. Future multicentre randomized clinical trials are needed to better ascertain the clinical efficacy of rTMS in the treatment of depression in the postpartum period.
BACKGROUND: Repetitive Transcranial Magnetic Stimulation (rTMS) has been suggested as an alternative treatment to postnatal depression (PPD). OBJECTIVES: This systematic review aims to examine and summarise evidence on rTMS efficacy in treating depression during the postnatal period. METHODS: We included randomized and non-randomized, single arm, and case report studies, with active rTMS and theta-burst stimulation, sham rTMS, pharmacotherapy or no treatment as comparators. Participants included women with PPD, who were administered rTMS after delivery and up to 12 months postpartum. The observed outcomes were response rate and acceptability. RESULTS: rTMS shows promising results, with clinically significant decreases in Edinburgh Postnatal Depression Scale (EPDS) scores at week 4 and an overall low risk of dropout. LIMITATIONS: The reduced number of reports, the lack of complete datasets and the serious/high risk of bias of the studies warrant cautious interpretations. CONCLUSIONS AND IMPLICATIONS: Despite the promising results, existing evidence on rTMS efficacy is limited, and questions remain on what the most beneficial stimulation parameters should be. Future multicentre randomized clinical trials are needed to better ascertain the clinical efficacy of rTMS in the treatment of depression in the postpartum period.
Authors: Ryan Chow; Eileen Huang; Allen Li; Sophie Li; Sarah Y Fu; Jin S Son; Warren G Foster Journal: BMC Pregnancy Childbirth Date: 2021-01-06 Impact factor: 3.007