Antidepressant effect r TMS during pregnancy in a case of Major Depression Resistant to Pharmacological Treatment

Abstract

Major depressive disorder (MDD) is a common complication of pregnancy and the postpartum period. Approximately 5% of women who have MDD during pregnancy or the postpartum period meet criteria for resistant depression, associated with increased morbidity in both the newborn and the pregnant woman. Currently we have different therapeutic options for the treatment of MDD during pregnancy, although in cases of resistance during that period the treatment criteria are not that well established.

We set out the case of a 36-year-old woman who presents an episode of major depression resistant to pharmacotherapy. During the current episode and after four cycles of failed pharmacological treatment she became pregnant. In the 16th week of gestation, she was treated with low-frequency repetitive transcranial magnetic stimulation (rTMS). After 30 treatment sessions, with good tolerance, the patient presented a complete recovery from the depressive symptoms, giving birth to a healthy newborn. rTMS is a good alternative to Electroconvulsive Therapy in some cases of resistant MDD during pregnancy. Despite these promising findings, further double-blind controlled studies with broad samples of pregnant women are required, with well-designed rTMS parameters, and even prospective studies (following pregnant women and their offspring) to confirm the absence of long-term side effects.