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mother with postpartum depression holds infant

Studies show an innovative approach to treatment called transcranial magnetic stimulation (TMS) may help women with post-partum depression when other therapies don’t work.

Depression Worldwide and in the United States

Depression and depressive diagnoses are the second most common mental health diagnoses in the world, second to anxiety and anxiety-related diagnoses. Here are the latest worldwide statistics on depression, as reported by the World Health Organization (WHO):

  • Total, all ages:
    • 3.8% of the world population experiences depression
    • That’s around 280 million people
  • Among adults:
    • 5.0% of adults 18+
    • 4.0% of men
    • 6.0% of women

In the United States, statistics from 2021 National Survey on Drug Use and Health (2021 NSDUH) show the following rates of major depressive episode (MDE) – a metric that serves as a proxy for clinical depression – among adults 18+:

  • 8.4% reported MDE in 2020
  • By gender:
    • 10.5% of females
    • 6.2% of males
  • 6.0% reported MDE with severe impairment
  • Reported MDE and received treatment for depression:
    • 66% of people with at least one MDE received treatment
    • 71% of people with MDE with severe impairment received treatment

Those figures tell us that in the U.S., around 20 million people have a depressive mental health diagnosis. Among those, close to 14 million report depression with severe impairment. And among those, around 10 million received treatment. However, evidence shows that among people who receive treatment for depression, around 30 percent do not respond to standard treatment with antidepressant  medication and psychotherapy.

Those figures tell us that in the U.S., around 20 million people have a depressive mental health condition. Among those, close to 14 million report depression with severe impairment. And among those, around 10 million received treatment. However, evidence shows that among people who receive treatment for depression, around 30 percent do not respond to standard treatment with antidepressant  medication and psychotherapy.

What is Depression?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) refers to depression as major depressive disorder (MDD), defined as follows:

“[MDD is] …an overwhelming feeling of sadness, isolation, and despair that last two weeks or longer at a time.”

The most common symptoms of depression are consistent low mood, feelings of hopelessness and pessimism, withdrawal from friends, family, and favorite activities, anger and irritability, fatigue, problems with memory and concentration, disrupted relationships, and more. For a complete list of symptoms of depression, please navigate to the blog section of our website and read this article:

The Difference Between Sadness & Depression

That information is on the most common type of depressive diagnosis, major depressive disorder (MMD). However, clinicians and mental health professionals identify several types of depression. One type is called post-partum depression (PPD).

What is Post-Partum Depression?

In the publication “Postpartum Depression,” mental health experts from the National Institutes of Health (NIH) offer the following definition of PPD:

Postpartum depression is diagnosed when at least five depressive symptoms [see list above] are present for at least 2 weeks. [PPD is] …a major depressive episode with the onset of pregnancy or within 4 weeks of delivery. The symptoms are present almost every day and represent a change from the previous routine. The diagnosis should include either depression or anhedonia (loss of interest) in addition to the five symptoms to be diagnosed.”

What that means is that PDD is MDD with an onset within a month of delivery. In addition to the symptoms common to MDD, the Centers for Disease Control (CDC) indicate that people with PDD may experience the following:

  • Daily crying/crying more than usual
  • Anger
  • Withdrawal from loved ones
  • Feeling disconnected from the baby
  • Worrying that they may harm the baby
  • Feelings of guilt about not being a good/good enough mother
  • Doubt about their ability to adequately take care of the baby

The risk factors for standard MDD include genetics, a family history or depression, a personal history of mental health challenges, a major injury or illness, major life changes and stress, and the presence of an alcohol or substance use disorder, among others.

The risk factors for PDD are the same as those for MDD, with the addition of the following:

  • Inadequate/low level of social support
  • Low level of family support
  • Problems/difficulties/challenges getting pregnant
  • Giving birth to more than one child at a time, e.g. twins, triplets, or more
  • Having a child during adolescence
  • Labor and delivery before the 37th week of pregnancy (preterm birth)
  • Complications during pregnancy
  • Complications during childbirth

It’s important to understand that PPD can develop among women who have a typical pregnancy and birth free of complications. Now let’s look at the rates of post-partum depression in the U.S.

Post-Partum Depression (PPD): Facts and Figures

To track the health of mothers and infants in the U.S., the CDC maintains a system called Pregnancy Risk Assessment Monitoring System (PRAMS). The PRAMS system collects information on “maternal attitudes and experiences before, during, and shortly after pregnancy.” Fifty different jurisdictions report detailed information to PRAMS, which accounts for 81 percent of all live births in the U.S.

In a special report on selected maternal and child health indicators for the years 2016-2020, the PRAMS system indicates the following rates of perinatal and post-partum depression.

Self-Reported Depression: 3 Months Before Pregnancy

  • 2016: 12.3%
  • 2017: 12.8%
  • 2018: 14.7%
  • 2019: 15.1%
  • 2020: 15.5%

Self-Reported Depression During Pregnancy

  • 2016: 11.6%
  • 2017: 12.0%
  • 2018: 14.1%
  • 2019: 14.8%
  • 2020: 15.2%

Depressive Symptoms After Pregnancy (PPD)

  • 2016: 12.8 %
  • 2017: 12.5 %
  • 2018: 13.4 %
  • 2019: 13.4%
  • 2020: 13.4%

In 2016, 12.8 percent of mothers reporting PPD reflected a total of 35,081. That number increased to 40,691 in 2020, an increase of 16 percent, which is 13.4 percent of mothers. One thing we observe here is that self-reported rates of depression before and during pregnancy were generally higher than those for self-reported rates of post-partum depression. This a de facto, nonclinical verification, of sorts, of the development of PPD as a unique type of depression, and separates it from the stress and worry that’s typically associated with pregnancy: the numbers are consistent, and different from those reported for peri- and ante-natal depression.

That’s the scope of the situation: each year, tens of thousands of women experience PPD. Now let’s look at the treatment we introduce in the beginning of this article – transcranial magnetic stimulation (TMS) – and discuss why it may be an appropriate treatment option for women with PPD.

Transcranial Magnetic Stimulation (TMS) for Post-Partum Depression: What is TMS?

Transcranial magnetic stimulation (TMS) is a safe and effective therapy that’s approved by the Food and Drug Administration (FDA) for the treatment of several mental health diagnoses, including:

  • Depression
  • Treatment-resistant depression
  • Depression with suicidal behavior
  • Suicidal ideation
  • Anxious depression
  • Obsessive-compulsive disorder (OCD)

TMS is a non-invasive, outpatient treatment. It works by emitting targeted electromagnetic pulses to specific brain areas through a specially designed device. In most treatment settings, patients sit in a chair in an office while a clinician places a coil – sometimes a cap – on the patient’s scalp and initiates the electromagnetic pulses.

One thing about TMS that’s attractive to new mothers is the fact the absence of systemic side effects. While not all antidepressants have side effects, many antidepressants include unwanted consequences such as agitation, weight gain, cognitive problems, nausea, insomnia, loss of appetite, loss of sex drive, and other sexual problems. None of these side effects are associated with TMS treatment. In addition, the therapeutic benefits appear more rapidly than the benefits of typical antidepressants, and last longer.

For those reasons, TMS may be an acceptable treatment for post-partum depression, as opposed to treatment with antidepressants. We should clarify something else: TMS is FDA-approved for the treatment of the diagnoses we mention above. However, the evidence we share below shows that TMS is also effective for PPD. When a treatment or medication is supported by evidence – but it’s not yet formally approved by the FDA – it’s allowed for what’s known as off-label use. In cases when both the patient and physician completely understand the risks and benefits of the treatment, the treatment is allowed, despite the absence of standard FDA approval.

TMS for Post-Partum Depression: Studies Show Symptom Reduction and Remission

We identified four separate studies that demonstrate the effectiveness of TMS for women with post-partum depression. These studies show treatment success analogous to the rates of success shown in the studies upon which the FDA based their approval for TMS for depression and the diagnoses we list above.

The study “Repetitive Transcranial Magnetic Stimulation for The Treatment Of Postpartum Depression,” published in 2020, showed the following:

  • Scores on the Beck Depression Inventory (BDI) decreased by 50%
  • Scores on the Edinburgh Postnatal Depression Scale (EPDS) decreased by 43%
  • Decreases in BDI and EPDS scores remained lower than baseline at three months and six months post treatment
  • 66.7% of participants achieved remission of symptoms that persisted for three months
  • 50% of participants achieved remission of symptoms that persisted for six months

Another study –  “Repetitive Transcranial Magnetic Stimulation Treats Postpartum Depression” – published in 2010, showed the following:

  • 88.9% of patients achieved remission within two weeks of treatment
  • 87.5% of patients who achieved remission reported remission persisted for at least 6 months after treatment

The study “Effects Of Repetitive Transcranial Magnetic Stimulation On Clinical, Social, And Cognitive Performance In Postpartum Depression,” published in 2012, showed the following:

  • Significant reduction in depressive symptoms
  • Significant reduction of severity of depression
  • Improved social function
  • Improved cognitive function

Finally, the study “Effectiveness of  transcranial magnetic stimulation (TMS) in patients with major depressive disorder with postpartum onset,” published in 2016, showed the following:

  • Scores on the Edinburgh Postnatal Depression Scale (EPDS) decreased by 60%
  • 74% of women achieved symptom remission within 8 weeks

That evidence provides another compelling reason women with PPD might choose treatment with TMS over treatment with standard antidepressants: it’s effective.

Tailored Treatment Meets Patient Needs: TMS for PPD

In healthcare and mental health treatment, providers often talk about offering individualized treatment plans that directly address the specific needs of each patient. They use this type of language because it reflects the current state of mental health treatment: what we know is that designing treatment plans that address the whole person – including the biological, psychological, and social factors in their lives – offer the best chance of treatment success.

For a new mother with PPD, the experience of pregnancy, childbirth, and becoming a mother qualify as all three: they’re biological, psychological, and social factors that change virtually everything in their lives. That’s why a treatment for depression that takes their recent pregnancy and current new-mom status into account is an important development. Transcranial magnetic stimulation (TMS) does not have the systemic side effects that concern women for their personal health. And since TMS doesn’t involve ingesting medication, there is no worry about the impact of antidepressants on the infant brain and body.

In most cases, treatment with TMS occurs alongside traditional psychotherapy – a.k.a. talk therapy – as well as lifestyle changes and social support. That’s the whole person, integrated approach to treatment: patients are more likely to achieve symptom reduction or full remission when treatment professionals consider the patient in a holistic manner, and help them address the challenges they face in all areas of their lives.

Seeking Help: TMS for Post-Partum Depression

In closing, we offer a reminder: an article like this cannot diagnose a person with PDD or recommend a course of treatment. The information above is to help patients understand what PDD and what TMS is, but only a licensed mental health professional can provide a clinical mental health diagnosis. We encourage new mothers who think they may have post-partum depression (PPD) to seek a comprehensive biopsychosocial assessment administered by a trained psychiatrist or therapist. A full assessment will confirm or eliminate a diagnosis of PPD, and the administering clinician can recommend a course of treatment that may include transcranial magnetic stimulation (TMS), as needed and if appropriate.

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