Is repetitive transcranial magnetic stimulation (rTMS) an effective and safe treatment option for postpartum and peripartum depression? A systematic review

Abstract

• Seven articles were included assessing the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS); four studies on postpartum depression, and three on depression during pregnancy. • RTMS shows promise as a safe treatment option with limited side effects and low dropout rates. • The existing research on the effectiveness of rTMS as a treatment for postpartum and peripartum depression is limited, underpowered, and has a high risk of bias. Depressive symptoms, postpartum and peripartum, can affect mothers' ability to nurture their children, and may have adverse impacts on social, cognitive, language, and self-concept development. Currently, postpartum and peripartum depression are treated through psychotherapy, electroconvulsive therapy (ECT), and pharmacotherapy. These treatments are moderately effective and may induce side effects that can negatively impact the mother-child relationship. Repetitive transcranial magnetic stimulation (rTMS) is a new treatment option with promise as an effective and safe treatment for postpartum and peripartum depression. Objective: We conducted a systematic review to assess the effectiveness and safety of rTMS as a treatment option for postpartum and peripartum depression. MEDLINE, PsycINFO, EMBASE, CINAHL, Scopus, The Cochrane Library, Theses and Dissertations Global database were searched. We included randomized and non-randomized studies that used rTMS as the primary treatment option for women with postpartum or peripartum depression as defined by the DSM or ICD. This review abides by the PRISMA 2009 guidelines. Results: A total of 537 articles were identified by the search, and seven articles met the inclusion criteria of the review accounting for a total of 110 participants. Four of the studies assessed rTMS as a treatment for postpartum depression, and three studies assessed rTMS as a treatment for depression during pregnancy. All seven articles suggest that rTMS is a promising treatment option, however, the two existing randomized controlled trials did not observe any statistically significant results. RTMS appears to be a safe treatment with limited side effects and low dropout rates. However, the existing research on rTMS as a treatment for postpartum and peripartum depression is limited and underpowered. More randomized controlled trials with larger sample sizes are needed to better assess the efficacy of rTMS as a treatment option for postpartum and peripartum depression.