Grand Rounds

Can Transcranial Magnetic Stimulation Safely Aid Women with Major Depression in Pregnancy?

BACKGROUND AND PURPOSE:

Transcranial magnetic stimulation (TMS) is used by psychiatric patients who do not want or can’t tolerate medications for the treatment of major depressive disorder (MDD)
MDD is common in pregnancy (10%)
Kim et al. (Brain Stimulation., 2018) assessed the efficacy and safety of TMS to treat pregnant women with MDD

Randomized controlled trial (RCT)
- Included women with MDD in the second or third trimester
Subjects were randomized to the following arms
- Active TMS
- Sham TMS
Subjects received
- 20 sessions of TMS to the right dorsolateral prefrontal cortex
- 1 Hz as a single train of 900 pulses per session at 100% motor threshold
Estradiol and progesterone were measured before session 1 and after session 2
Response: at least a 50% decrease from baseline Hamilton Depression Rating Scale (HDRS-17) score
Remission: HDRS-17 score <8 and a Clinical Global Impression Scale-Severity (CGI-S) score ≤1

22 women were included in the study
The active TMS group exhibited significantly reduced Hamilton Depression Rating Scale (HDRS-17) (p=0.003)
Response rates (p=0.088)
- 81.82% for the active TMS
- 45.45% for the sham coil
Remission rates (p=0.613)
- 27.27% for the active
- 18.18% for the sham coil
Late preterm birth (PTB) occurred in three women receiving active TMS
- 35.3, 36.3 and 35.2 weeks
- All other maternal and delivery outcomes were normal

Right-sided, low frequency TMS effectively reducing depressive symptoms in this sample based on the Hamilton scale, but was not significant with respect to response and remission rates as defined by this study
- Left-sided TMS is becoming standard of care
TMS May be associated with late PTB although a larger sample size would be needed
- Sample size not sufficiently large to determine if this finding is significant (would need 33 women in each arm)

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