rTMS and Pregnancy

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It is estimated that over 10% of pregnant women are depressed at any given time. Depression during pregnancy is associated with poorer outcomes for the baby, such as premature birth, lower birth weight, and higher rates of postnatal complications. Maternal depression may also affect the bonding process between mother and baby after birth.

rTMS Treatment for Depression During Pregnancy is Considered Safe

The National Institute for Clinical Excellence (NICE) states in its guidance on rTMS for the prevention of migraine that there is a role for this treatment in the reduction or avoidance of drug therapy in pregnancy.

Avoiding the use of drugs in the treatment of depression in pregnancy is also desirable.

As no sedation or analgesia is required, rTMS offers a powerful treatment without exposing the foetus to the potentially harmful effects of drugs that cross the placenta during pregnancy, or contaminate the mother’s milk during the nursing period.

Video: Dr Rafael Euba talks about depression and pregnancy in this informative seminar presented at
The Private Pregnancy UK Show 2016 in London.

There is limited experience of the use of rTMS in pregnancy. However, every report published so far in the medical literature clearly suggests that rTMS remains effective and safe during pregnancy:

  • Ten depressed women in the second or third trimester of pregnancy were treated with 20 low frequency rTMS sessions. Seven of ten improved. No adverse pregnancy or foetal outcomes were observed. Kim et al, 2011. An Open Label Pilot Study of Transcranial Magnetic Stimulation for Pregnant Women with Major Depressive Disorder JOURNAL OF WOMEN’S HEALTH 2011;20:255-261
  • Thirty depressed pregnant patients received high frequency rTMS for three weeks. The treatment was effective and well tolerated and no safety concerns were reported. Sayar et al. Transcranial magnetic stimulation during pregnancy. Archives of Women’s Mental Health 2013; DOI:10.1007/s00737-013-0397-0

Other published case studies, all of them with positive outcomes:

  • Nahas Z, Bohning DE, Molloy MA, Oustz JA, Risch SC, George MS: Safety and feasibility of repetitive transcranial magnetic stimulation in the treatment of anxious depression in pregnancy: a case report. J. Clin. Psychiatry 60(1), 50–52 (1999).
  • Klirova M, Novak T, Kopecek M, Mohr P, Strunzova V: Repetitive transcranial magnetic stimulation (rTMS) in major depressive episode during pregnancy. Neuro. Endocrinol. Lett. 29(1), 69–70 (2008).
  • Zhang D, Hu Z: RTMS may be a good choice for pregnant women with depression. Arch. Womens Ment. Health 12(3), 189–190 (2009).

In conclusion, rTMS should be considered as an option for those pregnant women who are depressed and who wish to avoid potentially harmful drugs during their pregnancy. The needs of each individual pregnant woman will need to be considered and an assessment of the potential benefits and risks of each specific intervention carried out, including psychotherapy. rTMS may also be an ideal treatment option for depression during the nursing period.

If you are pregnant and want to find out whether rTMS treatment is suitable for you, contact The London Psychiatry Centre.