Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2015-0076
Trends in Psychiatry and Psychotherapy
Review Article

Transcranial magnetic stimulation for treatment of major depression during pregnancy: a review

Estimulação magnética transcraniana para o tratamento de depressão maior durante a gestação: uma revisão

Renata de Melo Felipe; Ygor Arzeno Ferrão

http://dx.doi.org/10.1590/2237-6089-2015-0076 Trends Psychiatry Psychother, vol.38, n4, p.190-197, 2016
PDF
SciELO
Downloads: 0
Views: 427

Abstract

Abstract Introduction: Pregnancy is characterized by a high prevalence of mental disorders. Depression is the most common of these disorders and it is a risk factor for negative maternal and child development outcomes. Psychotherapy and pharmacotherapy are conventional and well-established therapeutic options, but some clients fail to respond and the safety of using some pharmacological agents during pregnancy is unclear. Some neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), have been studied in depressed pregnant women. Objective: To evaluate the safety and efficacy of rTMS for major depression in pregnant women. Methods: The LILACS and PubMed databases were reviewed using the search terms depression, pregnancy and magnetic stimulation. Texts including primary data, published in Portuguese, Spanish, or English, between 1995 and 2014, that evaluated depressed pregnant women and used rTMS as the intervention were selected. Papers lacking sufficient data were excluded. Twenty-two texts were initially identified; after applying the inclusion criteria, 12 were selected and analyzed. Results: The studies reviewed reported satisfactory responses to rTMS in acute depressive episodes, as measured using depressive symptom scales. Remission of symptoms was achieved in many cases. The procedure was well tolerated and there were no reports of damage/complications to unborn children. Conclusion: The data available at this time support the efficacy and tolerability of rTMS for depression in pregnant women. Controlled studies should corroborate this conclusion. This review only included studies in three languages and the resulting sample size was not large enough to conduct a meta-analysis.

Keywords

Pregnancy, depression, transcranial magnetic stimulation

Resumo

Resumo Introdução: A gestação é caracterizada por uma alta prevalência de transtornos mentais. A depressão é a mais comum entre essas doenças e é fator de risco para desfechos negativos maternos e de desenvolvimento da criança. Psicoterapia e farmacoterapia são opções terapêuticas convencionais e bem estabelecidas, mas algumas pacientes não apresentam resposta, e a segurança do uso de alguns psicofármacos durante a gestação não é clara. Algumas técnicas de neuromodulação, como estimulação magnética transcraniana repetitiva ( repetitive transcranial magnetic stimulation , rTMS), vêm sendo estudadas em gestantes com depressão. Objetivo: Avaliar a segurança e a eficácia da rTMS para depressão maior em mulheres gestantes. Métodos: As bases de dados LILACS e PubMed foram revisadas utilizando os termos depressão, gestação e estimulação magnética. Textos originais, publicados em português, espanhol, ou inglês, entre 1995 e 2014, que avaliaram gestantes com depressão e utilizaram rTMS como intervenção, foram selecionados. Artigos com dados insuficientes foram excluídos. Vinte e dois textos foram inicialmente identificados; após a aplicação dos critérios de inclusão, 12 foram selecionados e analisados. Resultados: Os estudos revisados demonstraram resposta satisfatória com rTMS em episódios depressivos agudos, avaliada com escalas de sintomas depressivos. Houve remissão em muitos casos. O procedimento foi bem tolerado e não houve relatos de danos/complicações aos bebês. Conclusão: Os dados disponíveis até o momento sugerem a eficácia e tolerabilidade de rTMS para depressão em gestantes. Estudos controlados devem corroborar esta conclusão. Esta revisão incluiu apenas estudos em três idiomas e resultou em um tamanho amostral insuficiente para conduzir uma metanálise.

Palavras-chave

Gestação, depressão, estimulação magnética transcraniana

References

Pereira PK, Lovisi GM. Prevalência da depressão gestacional e fatores associados. Rev Psiquiatr Clin. 2008;35:144-53.

Araujo DM, Vilarim MM, Sabroza AR, Nardi AE. Depression during pregnancy and low birth weight: a systematic literature review. Cad Saude Publica. 2010;26:219-27.

Botega NJ, Dias MK, Botega NJ. Gravidez e puerpério. 2006:341-54.

Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004;103:698-709.

Patel V, Prince M. Maternal psychological morbidity and low birth in India. Br J Psychiatry. 2006;188:284-5.

Rahman A, Iqbal Z, Bunn J, Lovel H, Harrington R. Impact of maternal depression on infant nutritional status and illness: a cohort study. Arch Gen Psychiatry. 2004;61:946-52.

Ciesielski TH, Marsit CJ, Williams SM. Maternal psychiatric disease and epigenetic evidence suggest a common biology for poor fetal growth. BMC Pregnancy Childbirth. 2015;15:192.

Nulman I, Koren G, Rovet J, Barrera M, Streiner DL, Feldman BM. Neurodevelopment of children prenatally exposed to selective reuptake inhibitor antidepressants: Toronto sibling study. J Clin Psychiatry. 2015;76:e842-7.

Nygaard L, Rossen CB, Buus N. Balancing risk: a grounded theory study of pregnant women's decisions to (dis)continue antidepressant therapy. Issues Ment Health Nurs. 2015;36:485-92.

Ram D, Gandotra S. Antidepressants, anxiolytics, and hypnotics in pregnancy and lactation. Indian J Psychiatry. 2015;57:S354-71.

Camacho RS, Cantinelli FS, Ribeiro CS, Cantilino A, Gonsales BK, Braguittoni E. Transtornos psiquiátricos na gestação e no puerpério: classificação, diagnóstico e tratamento. Rev Psiquiatr Clin. 2006;33:92-102.

Sutter-Dallay AL, Bales M, Pambrun E, Glangeaud-Freudenthal NM, Wisner KL, Verdoux H. Impact of prenatal exposure to psychotropic drugs on neonatal outcome in infants of mothers with serious psychiatric illnesses. J Clin Psychiatry. 2015;76:967-73.

Boothby LA, Doering PL. FDA labeling system for drugs in pregnancy. Ann Pharmacother. 2001;35:1485-9.

Myles N, Newall H, Ward H, Large M. Systematic meta-analysis of individual selective serotonin reuptake inhibitor medications and congenital malformations. Aust N Z J Psuchiatry. 2013;47:1002-12.

Kiele H, Artama M, Engeland A, Ericsson Ö, Furu K, Gissler M. Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: population based cohort study from the five Nordic countries. BMJ. 2012;344:d8012.

Nikfar S, Rahimi R, Hendoiee N, Abdollah M. Increasing the risk of spontaneous abortion and major malformations in newborns following use of serotonin reuptake inhibitors during pregnancy: a systematic review and updated meta-analysis. Daru. 2012;20:75.

Lefaucheur J, André-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol. 2014;125:2150-206.

Chervyakov AV, Chernyavsky AY, Sinitsyn DO, Piradov MA. Possible mechanisms underlying the therapeutic effects of transcranial magnetic stimulation. Front Hum Neurosci. 2015;9:303.

George MS, Post RM. Daily left prefrontal repetitive transcranial magnetic stimulation for acute treatment of medication-resistant depression. Am J Psychiatry. 2011;168:356-64.

Resolução CFM 1.986/2012. 2012.

Hızlı Sayar G, Ozten E, Tufan E, Cerit C, Kağan G, Dilbaz N. Transcranial magnetic stimulation during pregnancy. Arch Womens Ment Health. 2014;17:311-5.

Gahr M, Blacha C, Connemann BJ, Freudenmann RW, Schönfeldt-Lecuona C. Successful treatment of major depression with electroconvulsive therapy in a pregnant patient with previous non-response to prefrontal rTMS. Pharmacopsychiatry. 2012;45:79-80.

Kim DR, Epperson N, Pare E, Gonzalez JM, Parry S, Thase ME. An open label pilot study of transcranial magnetic stimulation for pregnant women with major depressive disorder. J Womens Health (Larchmt). 2011;20:255-61.

Zhang X, Liu K, Sun J, Zheng Z. Safety and feasibility of repetitive transcranial magnetic stimulation (rTMS) as a treatment for major depression during pregnancy. Arch Womens Ment Health. 2010;13:369-70.

Klirova M, Novak T, Kopecek M, Mohr P, Strunzova V. Repetitive transcranial magnetic stimulation (rTMS) in major depressive episode during pregnancy. Neuro Endocrinol Lett. 2008;29:69-70.

Eryilmaz G, Sayar GH, Özten E, Gül IG, Yorbik Ö, Isiten N. Follow-up study of children whose mothers were treated with transcranial magnetic stimulation during pregnancy: preliminary results. Neuromodulation. 2015;18:255-60.

Collins LM, Murphy SA, Strecher V. The Multiphase Optimization Strategy (MOST) and the Sequential Multiple Assignment Randomized Trial (SMART): new methods for more potent health interventions. Am J Prev Med. 2007;32:S112-8.

Rush AJ. Star-D: lessons learned and future implications. Depress Anxiety. 2011;28:521-4.

Berlim MT, McGirr A, Beaulieu MM, Turecki G. High frequency repetitive transcranial magnetic stimulation as an augmenting strategy in severe treatment-resistant major depression: a prospective 4-week naturalistic trial. J Affect Disord. 2011;130:312-7.

Prasser J, Schecklmann M, Poeppl TB, Frank E, Kreuzer PM, Hajak G. Bilateral prefrontal rTMS and theta burst TMS as an add-on treatment for depression: a randomized placebo controlled trial. World J Biol Psychiatry. 2015;16:57-65.

Berlim MT, Van den Eynde F, Daskalakis ZJ. High-frequency repetitive transcranial magnetic stimulation accelerates and enhances the clinical response to antidepressants in major depression: a meta-analysis of randomized, double-blind, and sham-controlled trials. J Clin Psychiatry. 2013;74:e122-9.

Valiengo LC, Bensen IM, Lotufo PA, Fraguas Jr R, Brunoni AR. Transcranial direct current stimulation and repetitive transcranial magnetic stimulation in consultation-liaison psychiatry. Braz J Med Biol Res. 2013;46:815-23.

Banks SJ, Eddy KT, Angstadt M, Nathan PJ, Phan KL. Amygdala-frontal connectivity during emotion regulation. Soc Cogn Affect Neurosci. 2007;2:303-12.

Kimbrell TA, Little JT, Dunn RT, Frye MA, Greenberg BD, Wassermann EM. Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism. Biol Psychiatry. 1999;46:1603-13.

Nobler MS, Teneback CC, Nahas Z, Bohning DE, Shastri A, Kozel FA. Structural and functional neuroimaging of electroconvulsive therapy and transcranial magnetic stimulation. Depress Anxiety. 2000;12:144-56.

Janicak PG, Dokucu ME. Transcranial magnetic stimulation for the treatment of major depression. Neuropsychiatr Dis Treat. 2015;11:1549-60.

Klein E, Kreinin I, Chistyakov A, Koren D, Mecz L, Marmur S. Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double-blind controlled study. Arch Gen Psychiatry. 1999;56:315-20.

George MS, Nahas Z, Molloy M, Speer AM, Oliver NC, Li XB. A controlled trial of daily left prefrontal cortex TMS for treating depression. Biol Psychiatry. 2000;48:962-70.

Speer AM, Kimbrell TA, Wassermann EM, D Repella J, Willis MW, Herscovitch P. Opposite effects of high and low frequency rTMS on regional brain activity in depressed patients. Biol Psychiatry. 2000;48:1133-41.

Lisanby SH, Husain MM, Rosenquist PB, Maixner D, Gutierrez R, Krystal A. Daily left prefrontal repetitive transcranial magnetic stimulation in the acute treatment of major depression: clinical predictors of outcome in a multisite, randomized controlled clinical trial. Neuropsychopharmacology. 2009;34:522-34.

Triggs WJ, Ricciuti N, Ward HE, Cheng J, Bowers D, Goodman WK. Right and left dorsolateral pre-frontal rTMS treatment of refractory depression: a randomized, sham-controlled trial. Psychiatry Res. 2010;178:467-74.

Fitzgerald PB, Hoy K, McQueen S, Herring S, Segrave R, Been G. Priming stimulation enhances the effectiveness of low-frequency right prefrontal cortex transcranial magnetic stimulation in major depression. J Clin Psychopharmacol. 2008;28:52-8.

Baeken C, Vanderhasselt MA, Remue J, Herremans S, Vanderbruggen N, Zeeuws D. Intensive HF-rTMS treatment in refractory medication-resistant unipolar depressed patients. J Affect Disord. 2013;151:625-31.

Ray S, Nizamie SH, Akhtar S, Praharaj SK, Mishra BR, Zia-ul-Haq M. Efficacy of adjunctive high frequency repetitive transcranial magnetic stimulation of left prefrontal cortex in depression: a randomized sham controlled study. J Affect Disord. 2011;128:153-9.

Kok RM, Heeren TJ, Nolen WA. Continuing treatment of depression in the elderly: a systematic review and meta-analysis of double-blinded randomized controlled trials with antidepressants. Am J Geriatr Psychiatry. 2011;19:249-55.

Warden D, Rush AJ, Wisniewski SR, Lesser IM, Kornstein SG, Balasubramani GK. What predicts attrition in second step medication treatments for depression? a STAR*D Report. Int J Neuropsychopharmacol. 2009;12:459-73.

Rosa AM, Odebrecht M, Rigonatti SP, Marcolin MA. Eletroconvulsoterapia e estimulação magnética transcraniana: semelhanças e diferenças. Rev Psiquiatr Clin. 2004;31:243-50.

Serafini G, Pompili M, Belvederi Murri M, Respino M, Ghio L, Girardi P. The effects of repetitive transcranial magnetic stimulation on cognitive performance in treatment-resistant depression. A systematic review. Neuropsychobiology. 2015;71:125-39.

Micallef-Trigona B. Comparing the effects of repetitive transcranial magnetic stimulation and electroconvulsive therapy in the treatment of depression: a systematic review and meta-analysis. Depress Res Treat. 2014:135049.

George MS, Nahas Z, Kozel FA, Li X, Denslow S, Yamanaka K. Mechanisms and state of the art of transcranial magnetic stimulation. J ECT. 2002;18:170-81.

6169eaa6a953955f2c1aa482 trends Articles
Links & Downloads
2238-0019 (Electronic)
Trends Psychiatry Psychother ©2024 All rights reserved.

Trends Psychiatry Psychother

Share this page
Page Sections