A survey of patient acceptability of repetitive transcranial magnetic stimulation (TMS) during pregnancy

Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, United States.
Journal of Affective Disorders (Impact Factor: 3.38). 03/2011; 129(1-3):385-90. DOI: 10.1016/j.jad.2010.08.027
Source: PubMed


Given the data that depression is common during pregnancy and that pregnant women prefer non-medication treatment options, we hypothesize repetitive transcranial magnetic stimulation (TMS) may be a treatment option. Given the novelty of TMS, we sought to assess whether patient acceptability would be a barrier to enrolling pregnant women in TMS studies.
In Study 1, 500 pregnant women were surveyed in an outpatient, urban obstetrics clinic using the Edinburgh Depression Rating Scale (EPDS) and a treatment acceptability survey. In Study 2, 51 women were surveyed with the EPDS and acceptability survey using an informational video to increase participant knowledge about TMS.
Approximately 25% of participants had an EPDS score of ≥12 in both studies. Psychotherapy was identified as the most acceptable treatment option. TMS was considered an unacceptable treatment option to virtually all women before the informational video. After the video, 15.7% considered TMS an acceptable treatment option.
Psychotherapy is the most acceptable treatment option for depression to pregnant women. Increasing participant knowledge about TMS increased its acceptability significantly. Large-scale multi-center trials are needed for confirmation of these results.

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    • "Characteristics of the sample screened with the EPDS have been published elsewhere (Kim et al. 2011). Briefly, 94 % of the cohort agreed to respond to the EPDS, and 95 % were insured by Medicaid. "
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    ABSTRACT: In this study, we evaluated the association between prenatal depression symptoms adverse birth outcomes in African-American women. We conducted a retrospective cohort study of 261 pregnant African-American women who were screened with the Edinburgh Postnatal Depression Scale (EPDS) at their initial prenatal visit. Medical records were reviewed to assess pregnancy and neonatal outcomes, specifically preeclampsia, preterm birth, intrauterine growth retardation, and low birth weight. Using multivariable logistic regression models, an EPDS score ≥10 was associated with increased risk for preeclampsia, preterm birth, and low birth weight. An EPDS score ≥10 was associated with increased risk for intrauterine growth retardation, but after controlling for behavioral risk factors, this association was no longer significant. Patients who screen positive for depression symptoms during pregnancy are at increased risk for multiple adverse birth outcomes. In a positive, patient-rated depression screening at the initial obstetrics visit, depression is associated with increased risk for multiple adverse birth outcomes. Given the retrospective study design and small sample size, these findings should be confirmed in a prospective cohort study.
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    • "It has been suggested that transcranial magnetic stimulation (TMS) might be an effective option for women with moderate to severe depression who prefer not to take medication during pregnancy (Kim, et al., 2011); however, there has been no research on the safety or efficacy of this treatment during pregnancy, and when pregnant women were asked whether they would consider this treatment, which involves daily office visits for four weeks, only 16% said they would consider it as an option if they needed mental health treatment (Kim, et al., 2011). "

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