University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal.
Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
J Psychiatr Res. 2021 Aug;140:443-460. doi: 10.1016/j.jpsychires.2021.06.005. Epub 2021 Jun 8.
Non-invasive brain stimulation (NIBS) techniques have been suggested as alternative treatments to decrease depression symptoms during the perinatal period. These include brain stimulation techniques that do not require surgery and that are nonpharmacological and non-psychotherapeutic. NIBS with evidence of antidepressant effects include repetitive transcranial magnetic stimulation (rTMS), transcranial electric stimulation (TES) and electroconvulsive therapy (ECT).
This systematic review aims to summarize evidence on NIBS efficacy, safety and acceptability in treating peripartum depression (PPD).
We included randomized, non-randomized and case reports, that used NIBS during pregnancy and the postpartum. The reduction of depressive symptoms and neonatal safety were the primary and co-primary outcomes, respectively.
rTMS shows promising results for the treatment of PPD, with clinically significant decreases in depressive symptoms between baseline and end of treatment and overall good acceptability. Although the safety profile for rTMS is adequate in the postpartum, caution is warranted during pregnancy. In TES, evidence on efficacy derives mostly from single-arm studies, compromising the encouraging findings. Further investigation is necessary concerning ECT, as clinical practice relies on clinical experience and is only described in low-quality case-reports.
The reduced number of controlled studies, the lack of complete datasets and the serious/high risk of bias of the reports warrant cautious interpretations.
Existing evidence is limited across NIBS techniques; comparative studies are lacking, and standard stimulation parameters are yet to be established. Although rTMS benefits from the most robust research, future multicenter randomized clinical trials are needed to determine the position of each NIBS strategy within the pathways of care.
非侵入性脑刺激 (NIBS) 技术已被提议作为替代治疗方法，以减少围产期的抑郁症状。这些技术包括不需要手术、非药物和非心理治疗的脑刺激技术。具有抗抑郁作用的 NIBS 包括重复经颅磁刺激 (rTMS)、经颅电刺激 (TES) 和电惊厥疗法 (ECT)。
本系统综述旨在总结围产期抑郁症 (PPD) 中使用 NIBS 的疗效、安全性和可接受性的证据。
我们纳入了在怀孕期间和产后使用 NIBS 的随机、非随机和病例报告。减少抑郁症状和新生儿安全性是主要和共同主要结局。
rTMS 治疗 PPD 显示出有前景的结果，与基线和治疗结束时相比，抑郁症状有明显的临床显著下降，整体可接受性良好。尽管 rTMS 在产后的安全性状况良好，但在怀孕期间仍需谨慎。在 TES 中，疗效的证据主要来自单臂研究，这影响了令人鼓舞的发现。还需要进一步研究 ECT，因为临床实践依赖于临床经验，并且仅在低质量的病例报告中描述。
对照研究数量减少、数据集不完整以及报告的严重/高偏倚风险，这使得对结果的解释需要谨慎。
现有的证据在各种 NIBS 技术中都是有限的；缺乏比较研究，并且尚未确定标准的刺激参数。尽管 rTMS 得益于最有力的研究，但仍需要进行多中心随机临床试验，以确定每种 NIBS 策略在治疗途径中的地位。
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