How AIIMS is using Repetitive Transcranial Magnetic Stimulation (rTMS) therapy to help pregnant women deal with depression
Thirty-year-old Karishma Sharma (name changed), a resident doctor working with a government hospital in Delhi, slipped into depression as she dealt with challenges in completing her education and loss of a close family member. Working hard to prove a point, she ignored consultation to deal with it. When she got married, other priorities took over. However, as she was undiagnosed for a long time, the severity of her depression increased when she became pregnant.
Experts say women are more at risk of depression while being pregnant than after delivery, the latter commonly understood as the baby blues or post-partum depression. According to AIIMS psychiatry professor, Dr Nand Kumar, “Pregnant women with depression tend to receive less prenatal care, don’t eat as well and don’t get enough rest. Their mental health troughs are enough to cause a miscarriage or pre-term births.”
Karishma’s mental health curve was plunging low when she visited the AIIMS psychiatry department for her check-up. Considering her pregnancy, doctors decided against antidepressants and opted for a Repetitive Transcranial Magnetic Stimulation (rTMS) therapy. Simply put, this uses electromagnetic fields to generate electrical impulses in specific regions of the brain that are known to modulate moods. It is non-invasive and safe. All doctors do is place an electromagnetic coil on your scalp. This coil delivers magnetic pulses that stimulate nerve cells in the region of your brain that have decreased activity during a bout of depression. Once activated, the patient has no complaint for about six months.
AIIMS Delhi is the first institution to employ this neuromodulation tool for treating depression in pregnant women. Dr Kumar says that it has also shown significant improvement in treating several psychiatric and neuro-psychiatric disorders, including depression, obsessive compulsive disorder and migraine. “The rTMS wasn’t prescribed for pregnant women earlier but with more research and refinement, it has been found to be safe for pregnant women,” he adds. According to a study presented at the 12th World Congress of Biological Psychiatry in Athens, rTMS can be an alternative therapy for pregnant women experiencing depression.
The study noted how in a randomised controlled trial, the rTMS treatment was well-tolerated by women and no significant adverse effects were reported. It was also found to be statistically and clinically effective in pregnant patients with treatment-resistant depression.
According to a study published in Jama Network, depressive and anxiety disorder treatment during pregnancy remains clinically challenging because of safety concerns about antidepressant use during pregnancy. Dr Kumar says that a magnetic stimulator coil generates a very high magnetic field like an MRI machine–1.82 to 2 Tesla. “The magnetic field is in the centre of the coil. The resolution of this coil is half to one centimetre, so it can stimulate the equivalent area in the brain. No anaesthesia is required, therapists mark the area and calculate the brain’s threshold, which appears in the connected screen display,” he explains. “Once the patient goes through depression, the metabolism slows down in one of the cognitive areas of the brain. Through rTMS, we can stimulate this spot. The rTMS has high and low frequencies that can be modulated. A low frequency calms the hyperactive brain, a high frequency activates a dull one. If there is a head injury or stroke that slows down functionality, then rTMS can increase activity,” he adds. Besides, the therapy is very convenient. All you need is three minutes per session, spread over two weeks.
