Repetitive Transcranial Magnetic Stimulation (rTMS) Treats Postpartum Depression (PPD)

Keith S. Garcia, MD, PhD; Patricia M. Flynn, RN, BSN; and Katherine J. Pierce, PhD
Washington University School of Medicine, St. Louis, Missouri

This poster presentation was supported by a university grant.

Background: Postpartum depression (PPD) is a prevalent illness, affecting 10–15% of new mothers. PPD is the most common complication of childbirth and is a significant public health concern. It is known to adversely impact maternal-infant bonding, childrearing practices, and can lead to suicide and infanticide. The current treatment approaches to PPD are suboptimal. Many mothers are reluctant to take medication due to concerns about side effects or exposure of the newborn through breastfeeding. The specific aims of this study were to (1) examine acute treatment effectiveness, (2) examine response durability, and (3) assess an effect of rTMS on maternal bonding.

Methods: Nine antidepressant-free women with PPD were given twenty rTMS treatments over four weeks (10 Hz, 120% motor threshold, left dorsolateral prefrontal cortex). Multiple characteristics were assessed at baseline and throughout treatment. Duration of effect was assessed at 30 days, three months, and six months post-treatment.

Results: Friedman’s tests were conducted on Hamilton Rating Scale for Depression-24 item (HAMD-24), Edinburgh Postnatal Depression Scale (EPDS), Inventory of Depressive Symptomatology–Self Report (IDS-SR) and Clinical Global Impressions–Severity (CGI-S) scores to compare performances at four time points (baseline, end of week 2, end of week 4, 180-day follow-up). Overall, these results revealed a significant reduction in depressive symptoms by the end of week 2 of treatment. Analyses yielded a medium effect size (r=0.68) on the primary outcome variable (HAMD-24). Of note, all nine patients remained in treatment for the complete four weeks, did not miss any treatment sessions, and eight participants achieved remission of symptoms, defined as a HAMD <10 and a CGI-S=1. Analysis of follow-up data indicated robustness of the rTMS treatment over time. At six-month follow-up, of the eight women that remitted, seven remained in remission without further psychiatric intervention, including the addition of medication, and one was lost to follow-up. Results also indicated a significant improvement in maternal-infant bonding.

Conclusions: Our results demonstrate promising results for the use of rTMS in the treatment of PPD. Further randomized, sham-controlled studies need to be completed.

References
Wisner KL, Chambers C, Sit DK. Postpartum depression: a major public health problem. JAMA. 2006;296(21):2616–2618.

O'Reardon JP, Solvason HB, Janicak PG, et al. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007;62(11):1208–1216.

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