Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive Campus Box 7160, Chapel Hill, NC 27514, United States.
Disability Determination Services, 40 Fountain Street, Providence, RI 02903, United States.
J Affect Disord. 2020 Mar 1;264:193-200. doi: 10.1016/j.jad.2019.11.069. Epub 2019 Nov 13.
Postpartum depression (PPD) is a common and gravely disabling health concern. Repetitive transcranial magnetic stimulation (rTMS) is an FDA approved treatment for major depression and may be a valuable tool in the treatment of PPD. The treatment effect of rTMS is rapid, generally well tolerated, without systemic effects, and without medication exposure to a fetus and/or breastfed infant.
Six women with PPD received 20 sessions of 10 Hz rTMS over the left dorsolateral prefrontal cortex (DLPFC) over a 4 week period. Psychiatric rating scales (BDI, EPDS, STATI), cognitive assessments (MMSE, Trails B, List Generation) and breastfeeding practices were surveyed at baseline and post rTMS treatment. BDI and EPDS were obtained weekly, as well as 3 months and 6 months post study conclusion.
Average BDI, EPDS, and STAI scores declined over the 4-week duration of rTMS treatment. Of the six patients, four achieved remission as assessed by EPDS and one achieved remission and two responded as assessed by BDI. Mean BDI and EPDS scores at 3 and 6 months follow-up remained below levels at study entry. No evidence of cognitive changes or breastfeeding disruptions.
This was an exploratory study with small sample size with no sham control arm. Daily administration of rTMS provides potential for confounding of behavioral activation in the otherwise often isolative postpartum period.
rTMS was safe and well tolerated among participants with evidence of sustained improvements in depression and anxiety scores. This study supports rTMS as a promising non-pharmacologic treatment modality for perinatal depression.
产后抑郁症（PPD）是一种常见且严重的致残性健康问题。重复经颅磁刺激（rTMS）是 FDA 批准的治疗重度抑郁症的方法，可能是治疗 PPD 的一种有价值的工具。rTMS 的治疗效果迅速，通常耐受性良好，没有全身作用，并且不会对胎儿和/或哺乳期婴儿暴露于药物。
六名患有 PPD 的妇女在四周的时间内接受了 20 次 10Hz rTMS 治疗，刺激左背外侧前额叶皮质（DLPFC）。在基线和 rTMS 治疗后，调查了精神病学评定量表（BDI、EPDS、STATI）、认知评估（MMSE、Trails B、List Generation）和母乳喂养实践。BDI 和 EPDS 每周获得一次，以及研究结束后 3 个月和 6 个月获得一次。
在 rTMS 治疗的 4 周期间，平均 BDI、EPDS 和 STAI 评分下降。在六名患者中，四名患者根据 EPDS 评估达到缓解，一名患者根据 BDI 评估达到缓解和两名患者有反应。3 个月和 6 个月随访时的平均 BDI 和 EPDS 评分仍低于研究开始时的水平。没有认知变化或母乳喂养中断的证据。
这是一项具有小样本量的探索性研究，没有假对照臂。rTMS 的日常给药可能会混淆在产后期间通常孤立的行为激活。
rTMS 在参与者中是安全且耐受良好的，有证据表明抑郁和焦虑评分持续改善。这项研究支持 rTMS 作为围产期抑郁症有前途的非药物治疗方法。
