A case series of repetitive transcranial magnetic stimulation in the treatment of major depression during pregnancy

A, Yee; E, Pedersen; M, Koo

Abstract:

Past research on repetitive transcranial magnetic stimulation (rTMS) supports rTMS as a safe and effective treatment for pregnant women with major depressive disorder (MDD). Data suggests that, compared to ECT, rTMS has fewer side effects for both mother and fetus [[8]]. Research to date using rTMS for the treatment of MDD during pregnancy has investigated lower motor threshold (MT) percentages, reduced pulses per session, and fewer total number of sessions compared to standard of care rTMS protocols. We conducted a case series of pregnant women with MDD treated with full intensity rTMS to evaluate efficacy and safety. Five pregnant patients, aged 32–38, were treated with rTMS during their second or third trimester of pregnancy at a single clinical site, Neuro Wellness Spa Manhattan Beach, between 2017 and 2021. Prior to the initiation of rTMS, all five patients met criteria for major depressive disorder, recurrent (based on DSM-V diagnostic criteria) of moderate to severe severity (based on a 9-item Patient Health Questionnaire [PHQ-9] score ≥10 or a PHQ-9 score ≥20, respectively). PHQ-9 was assessed at baseline and around session 30. Neonatal records documenting gestational age, maternal/infant complications, and APGAR scores were reviewed. Headache in one patient, leading to rTMS discontinuation after 29 sessions, was the only adverse event. The results, however, suggest that full intensity rTMS was a safe and effective treatment for these patients with MDD during their second and third trimester of pregnancy. 100% responded to treatment, and 80% achieved remission. These results support previous research of rTMS as an effective treatment for women experiencing peripartum depression [[9],[10]]. Compared to past rTMS studies during pregnancy utilizing reduced intensity rTMS, this study demonstrates higher response and remission percentages [[9],[10]].

Patologie/Applicazioni:

• Depressione
• Stimolazione Magnetica Transcranica (TMS)
• Donne in gravidanza
• Theta Burst

Anno:

2022

Tipo di pubblicazione:

Articolo

Parola chiave:

rTMS; depressione; MDD; MagVenture; TBS

Testata scientifica:

Brain Stimulation

Nota:

Studio sulla Stimolazione Magnetica Transcranica ripetitiva (rTMS) con modalità di stimolazione intensiva condotto su 5 donne in stato do gravidanza affette da depressione maggiore (MDD). La stimolazione è stata eseguita con uno strumento MagPro R0 della MagVenture seguendo un protocollo atipico caratterizzato dalla combinazione di stimolazione ad impulso singolo (SP) e stimolazione theta burst (TBS). In particolare nella stessa seduta è stata eseguita una stimolazione di tipo iTBS (intermitted theta burst stimulation) e rTMS standard a 10 Hz sulla DLPFC di sinistra suguita da una cTBS (continuous theta burst stimulation) sulla DLPFC di destra. Finite le somministrazioni è stata riscontrata una diminuzione di oltre il 50% nei punteggi della PHQ-9 determinando quindi una risposta significativa delle pazienti al trattamento. Non sono stati riscontrati problemi né per la gravidanza né per il parto e tutti i neonati sono nati sani con un punteggio APGAR compreso tra 8.6 e 8.8. Per approfondimenti leggere l'articolo completo

DOI:

https://doi.org/10.1016/j.brs.2022.01.021