Prolonged transcranial magnetic stimulation in a pregnant patient with treatment-resistant depression: a case report.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Journal of Medical Case Reports Pub Date : 2024-10-23 DOI:10.1186/s13256-024-04855-y
Rana Jawish, Marcela Smid, Adam Gordon, Kathleen Shangraw, Brian J Mickey
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Abstract

Introduction: Perinatal depression is a serious and highly prevalent medical condition in the USA. Nearly 85% of individuals with perinatal depression go untreated, leading to significant morbidity and mortality. There is an urgent need to develop and advance safe and effective treatments for perinatal depression. Transcranial magnetic stimulation is an established intervention for depression in non-pregnant individuals yet is not well studied in perinatal depression.

Case presentation: A 33-year-old pregnant Latina female presented with severe, recurrent, treatment-resistant depression and suicidal ideation. The patient had previously trialed psychotherapy, multiple antidepressants, and mood stabilizers and had achieved remission with lithium prior to pregnancy. Due to pregnancy and fetal safety concerns, the patient discontinued lithium and consequently suffered progressive worsening of perinatal depression. At 24 weeks gestation and after additional failed medication trials, a prolonged course of transcranial magnetic stimulation was initiated. Following 46 transcranial magnetic stimulation treatments over 9 weeks using two protocol types (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation), she achieved near-remission of perinatal depression and resolution of suicidal ideation. There were no identified maternal or fetal adverse events at 6 weeks post-delivery.

Conclusion: To our knowledge, this is the first published case of a pregnant individual with perinatal depression who received and tolerated a prolonged transcranial magnetic stimulation course with two distinct protocols (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation) with clinically significant response. Transcranial magnetic stimulation is a well-tolerated and effective intervention that warrants further investigation for use in treatment-resistant perinatal depression.

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经颅磁刺激治疗一名妊娠期抑郁症患者:病例报告。
简介在美国,围产期抑郁症是一种严重且高发的疾病。近 85% 的围产期抑郁症患者未经治疗,导致严重的发病率和死亡率。开发和推广安全有效的围产期抑郁症治疗方法迫在眉睫。经颅磁刺激是一种治疗非孕妇抑郁症的成熟干预方法,但对围产期抑郁症的研究并不充分:病例介绍:一名 33 岁的拉丁裔女性孕妇患有严重的、反复发作的、难治性抑郁症和自杀倾向。该患者曾试用过心理疗法、多种抗抑郁药物和情绪稳定剂,并在怀孕前使用锂剂获得了缓解。出于对妊娠和胎儿安全的考虑,患者停用了锂剂,结果导致围产期抑郁症逐渐恶化。在妊娠 24 周时,经过多次药物治疗失败后,患者开始接受长期的经颅磁刺激治疗。在使用两种方案类型(重复经颅磁刺激和间歇θ脉冲刺激)对患者进行了为期9周的46次经颅磁刺激治疗后,她的围产期抑郁症几乎得到了缓解,自杀倾向也得到了消除。分娩后 6 周,未发现母体或胎儿出现不良反应:据我们所知,这是第一例公开发表的围产期抑郁症孕妇接受并耐受了两种不同方案(重复经颅磁刺激和间歇θ脉冲刺激)的长期经颅磁刺激疗程并获得显著临床反应的病例。经颅磁刺激是一种耐受性良好且有效的干预措施,值得进一步研究用于治疗耐药性围产期抑郁症。
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来源期刊
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
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