Efficacy of non-invasive brain stimulation in decreasing depression symptoms during the peripartum period: A systematic review
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Elsevier
Materia
Peripartum Perinatal Depression Non-invasive brain stimulation Systematic review
Date
2021-06-08Referencia bibliográfica
Francisca Pacheco... [et al.]. Efficacy of non-invasive brain stimulation in decreasing depression symptoms during the peripartum period: A systematic review, Journal of Psychiatric Research, Volume 140, 2021, Pages 443-460, ISSN 0022-3956, [https://doi.org/10.1016/j.jpsychires.2021.06.005]
Sponsorship
Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES) 0653/2018; CAPES/PrInt 88887.310343/2018-00Abstract
Background: Non-invasive brain stimulation (NIBS) techniques have been suggested as alternative treatments to
decrease depression symptoms during the perinatal period. These include brain stimulation techniques that do
not require surgery and that are nonpharmacological and non-psychotherapeutic. NIBS with evidence of antidepressant
effects include repetitive transcranial magnetic stimulation (rTMS), transcranial electric stimulation
(TES) and electroconvulsive therapy (ECT).
Objectives: This systematic review aims to summarize evidence on NIBS efficacy, safety and acceptability in
treating peripartum depression (PPD).
Methods: We included randomized, non-randomized and case reports, that used NIBS during pregnancy and the
postpartum. The reduction of depressive symptoms and neonatal safety were the primary and co-primary outcomes,
respectively.
Results: rTMS shows promising results for the treatment of PPD, with clinically significant decreases in depressive
symptoms between baseline and end of treatment and overall good acceptability. Although the safety profile for
rTMS is adequate in the postpartum, caution is warranted during pregnancy. In TES, evidence on efficacy derives
mostly from single-arm studies, compromising the encouraging findings. Further investigation is necessary
concerning ECT, as clinical practice relies on clinical experience and is only described in low-quality case-reports.
Limitations: The reduced number of controlled studies, the lack of complete datasets and the serious/high risk of
bias of the reports warrant cautious interpretations.
Conclusions and implications: Existing evidence is limited across NIBS techniques; comparative studies are lacking,
and standard stimulation parameters are yet to be established. Although rTMS benefits from the most robust
research, future multicenter randomized clinical trials are needed to determine the position of each NIBS strategy
within the pathways of care.