Neuromodulation and antenatal depression: a review

Abstract

BackgroundDepression during pregnancy affects 5%–8% of women. While the percentage of women in the US taking serotonin reuptake inhibitors during pregnancy has risen over the last decade, pregnant women continue to report that they prefer non-pharmacologic interventions.ObjectiveWe review the literature regarding neuromodulation techniques for major depressive disorder during pregnancy. The rationale for their use in this population, new developments, and future directions are discussed.MethodsA literature search was conducted in PubMed Plus, Ovid Medline, and Embase to collect all articles on neuromodulation for the treatment of depression during pregnancy. Key search words included electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation, transcranial direct current stimulation, neuromodulation, depression, and pregnancy. Given the sparse literature, all articles from 1960 to 2014 that addressed the use of neuromodulation in pregnancy were included.ConclusionThe data support the use of electroconvulsive therapy in all trimesters of pregnancy for major depressive disorder. New data are emerging for the use of transcranial magnetic stimulation in pregnancy, which is likely safe, but more data are needed before it can be recommended as a primary treatment modality during pregnancy. Other neuromodulation techniques have not been well studied in this population.

Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development

“…Although guidelines for the use of ECT in pregnancy have been published [99], there is no RCT level data for the use of ECT in the treatment of PPD. Additional neuromodulation techniques including repetitive transcranial magnetic stimulation [100][101][102] and transcranial direct current stimulation [103] are in initial trial stages for the treatment of PPD [104]. Further RCTs should examine the efficacy of ECT versus pharmacotherapy in severe PPD and the utility of other non-invasive neuromodulation interventions.…”

British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017

“…Overall, ECT is considered a possible treatment for severe depression during pregnancy but it should be used with caution, especially if there is a risk of vaginal bleeding or preterm birth (Kim et al, 2015; National Institute for Health and Care…”

“…Guidance exists for its use (Kim et al, 2015;Miller, 1994;O'Reardon et al, 2011;Royal College of Psychiatrists, 2012).…”

“…There are limited long-term follow up data of babies born to mothers treated with ECT during pregnancy other than a small case series and case reports and further data are required (Kim et al, 2015).…”

Influences of Maternal Vulnerability and Antidepressant Treatment during Pregnancy on the Developing Offspring

“…Depressive symptoms during pregnancy are not uncommon; in fact, 20% of women experience some depressive symptoms during any time of their pregnancy [1]. The number of women who suffer from major depression during pregnancy is estimated to be 4-8% [2,3]. According to the DSM-5, this disorder is characterized by a depressed mood or loss of interest or pleasure in daily activities for more than 2 weeks.…”