The therapeutic effect of repetitive transcranial magnetic stimulation in combination with cognitive behavior therapy for postpartum depression

Abstract

Objective To explore the therapeutic effect and the influence factors of repetitive transcranial magnetic stimulation (rTMS) in combination with cognitive behavior therapy(CBT) for postpartum depression. Methods One hundred and fifty patients with postpartum depression were recruited and stratified according to their education level (education 8-13 years or education ≥ 14 years) and age (18-29 year or 30-39 year). Patients were allocated to rTMS in combination with CBT and placebo (rTMS+ CBT+ placebo) group or paroxetine in combination with CBT and sham rTMS (paroxetine + CBT+ sham rTMS)group or paroxetine alone group according to their stratification and outpatient number order.The patients were treated for 4 weeks,and were assessed at baseline, 1st, 2nd and 4th weekend using 17-item Hamilton Rating Scale and Treatment Emergent Symptom Scale(TESS).Variance analysis(ANOVA),repeated ANOVA and linear mixed effect model were applied for continuous variables analysis and Cruskal-Wallis H test and rank-sum test were applied for categorical variables, inspection. Results (1)There was no significant difference in HAMD17 among three groups at baseline(F=0.547, P=0.580).(2)At the 4th weekend, the response rate was 98.00% in rTMS+CBT+ placebo group and 100.00% in paroxetine+CBT+sham rTMS group, which were significantly higher than that of paroxetine aline group(83.67% , Z=-5.428- -4.500, P= 0.000).The remission rate was 60.00% in rTMS+CBT+ placebo group and 68.75% in paroxetine+CBT+sham rTMS group,which were significantly higher than that of paroxetine alone group (20.41%, Z=-4.767- -3.993, P=0.000).(3)No significant difference in HAMD17 score of different layers(stratified according to education level and age) among three groups were detected at baseline (F=0.019-1.133, P=0.346-0.996).(4)At the 4th weekend,in rTMS+ CBT+ placebo and paroxetine+ CBT+ sham rTMS group, patients with higher education level showed significantly lower HAMD17 scores than patients with lower education level(Linear mixed effect model analysis without a corresponding test values, P<0.05);conversely,in paroxetine alone group,patients with higher education level showed significantly higher HAMD17 score than patients with lower education level(linear mixed effect model analysis without a corresponding test values, P<0.01). Conclusion rTMS in combination with CBT had obvious augmentative therapeutic effect for postpartum depression.CBT may be more appropriate for patients with higher education. Key words: Depression, postpartum; Transcranial magnetic stimulation; Cognitive therapy; Treatment outcome