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Date of Award

Spring 2022

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Sharonda Felton

Abstract

Background. Perinatal depression places a burden on families, the healthcare system, and the economy. Currently, treatment includes therapy and medications such as serotonin reuptake inhibitors. However, the use of antidepressant medications during pregnancy places the fetus at risk of birth defects and may pass to the infant during breastfeeding. Moreover, certain patients may have refractory depression that remains uncontrolled on medication. This study discusses the use of transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) during the perinatal period as a potential alternative or supplement to medication.

Objective. This study utilizes existing research articles to make a comparison of ECT and TMS therapy in treating pregnant and postpartum patients diagnosed with major depressive disorder (MDD).Considerations include safety for the mother and baby and improvement in symptoms.

Methods. In 2021, a PRISMA search was performed on several databases. Study populations were limited to pregnant and postpartum patients within one year of delivery. Other inclusion criteria for articles were English language, research study, diagnosis of MDD, TMS or ECT treatment alone or in combination with pharmacotherapy, and use of a quantitative depression scale. Databases included Science Direct, PubMed, EBM Review, and EBSCO Host.

Results. The database search resulted in 1,672 results and 646 discrete articles after removing duplicates. Using the inclusion and exclusion criteria, this was then reduced to 11 articles. In general, depression survey scores were used to determined study outcomes.

Conclusion. Both ECT and TMS studies showed significant improvement in patient depressive symptoms. None of the ECT studies considered long-term outcomes. Of the 3 TMS studies that reviewed long-term effects, 2 reported statistically significant decrease in depression scores at 6 months. There were no serious, adverse maternal or infant events associated with ECT or TMS.

Additional Files

PBH 696 Poster Presentation 2.pdf (725 kB)
Poster

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Comparison of electroconvulsive therapy and transcranial magnetic stimulation for perinatal depression

Background. Perinatal depression places a burden on families, the healthcare system, and the economy. Currently, treatment includes therapy and medications such as serotonin reuptake inhibitors. However, the use of antidepressant medications during pregnancy places the fetus at risk of birth defects and may pass to the infant during breastfeeding. Moreover, certain patients may have refractory depression that remains uncontrolled on medication. This study discusses the use of transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) during the perinatal period as a potential alternative or supplement to medication.

Objective. This study utilizes existing research articles to make a comparison of ECT and TMS therapy in treating pregnant and postpartum patients diagnosed with major depressive disorder (MDD).Considerations include safety for the mother and baby and improvement in symptoms.

Methods. In 2021, a PRISMA search was performed on several databases. Study populations were limited to pregnant and postpartum patients within one year of delivery. Other inclusion criteria for articles were English language, research study, diagnosis of MDD, TMS or ECT treatment alone or in combination with pharmacotherapy, and use of a quantitative depression scale. Databases included Science Direct, PubMed, EBM Review, and EBSCO Host.

Results. The database search resulted in 1,672 results and 646 discrete articles after removing duplicates. Using the inclusion and exclusion criteria, this was then reduced to 11 articles. In general, depression survey scores were used to determined study outcomes.

Conclusion. Both ECT and TMS studies showed significant improvement in patient depressive symptoms. None of the ECT studies considered long-term outcomes. Of the 3 TMS studies that reviewed long-term effects, 2 reported statistically significant decrease in depression scores at 6 months. There were no serious, adverse maternal or infant events associated with ECT or TMS.