Transcranial magnetic stimulation in the treatment of depression during pregnancy: a review
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REVIEW ARTICLE
Transcranial magnetic stimulation in the treatment of depression during pregnancy: a review Tobias Hebel 1 & Martin Schecklmann 1 & Berthold Langguth 1 Received: 9 April 2019 / Accepted: 8 August 2019 # Springer-Verlag GmbH Austria, part of Springer Nature 2019
Abstract The aim of this study is to elucidate the role of repetitive transcranial magnetic stimulation (rTMS) for treating depression during pregnancy. The treatment of depression in pregnant women poses a number of therapeutic challenges. Psychotherapy can be beneficial but is associated with limited availability and possibly an onset of effect which may be too long to be acceptable. Pharmacotherapy is limited by concerns of fetotoxicity, both real and possibly exaggerated in the view of patients and caregivers alike. While efficacy and safety of rTMS are well established for the treatment of depression, the available data for use in pregnancy is still sparse. We reviewed the available literature on the topic on PubMed. In addition to a number of case reports, three studies concerning the treatment of depressed pregnant women with rTMS are available. According to the data, rTMS seems to be safe for both the pregnant woman and her unborn offspring. No obstetric complications or adverse postnatal effects on development have been reported. rTMS alleviated depressive symptoms better than sham treatment in one study. rTMS seems to be safe and effective in treating depression in pregnant women. Further studies with larger numbers of participants are warranted to further clarify the significance of rTMS for the treatment of depression in pregnancy. Keywords Transcranial magnetic stimulation . rTMS . Depression . Pregnancy . Prenatal
Introduction Depressive illness during pregnancy does not only diminish quality of life but can also be associated with major negative biomedical and psychosocial consequences for the mother and her offspring before and after birth. Maternal depressive illness is associated with preterm birth, low birth weight, and lower APGAR scores and even congenital malformations (Raisanen et al. (2014), (Ciesielski et al. 2015; Becker et al. 2016) and behavioral disturbances in the course of child development (Deave et al. 2008; Pearlstein 2015). Apart from supportive measures, the main treatment options for depression are psychotherapy and antidepressive pharmacotherapy. The former may be associated with long waiting periods to gain access to a practitioner. The latter is limited in the case of the pregnant patient by concerns of
* Tobias Hebel [email protected] 1
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
fetotoxicity, both real and exaggerated in the minds of patients, relatives, and also practitioners. In any case, risks and benefits must be weighed, between potentially harming mother and unborn child by treatment on the one hand and harming them by withholding effective treatment on the other (Bonari et al. 2005; Hayes et al. 2012; Nulman et
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