Effects of repetitive transcranial magnetic stimulation on clinical, social, and cognitive performance in postpartum depression

Figures & data

Table 1 Demographic data, diagnostic/clinical data, and baseline rating scale scores for patients receiving repetitive transcranial magnetic stimulation (active or sham group)*

Characteristic	Active rTMS n = 8	Sham rTMS n = 6	P-value
Age of the mother (years)	29.63 ± 6.37	26.67 ± 7.15	0.440^a
Age of the infant (months)	4.13 ± 2.85	3.50 ± 2.74	0.507^b
Maternal years of schooling	12.75 ± 2.55	11.50 ± 2.74	0.403^a
Number of infant	1.50 ± 0.76	1.00 ± 0.00	0.105^b
Socioeconomic class (ABIPEME)
A or B, n (%)	3 (37.5)	2 (33.3)	0.334^c
C, n (%)	4 (50)	1 (16.7)
D or E, n (%)	1 (12.5)	3 (50)
Marital status**
Partner, n (%)	8 (100)	2 (33.3)	0.015^c
No partner, n (%)	0 (0)	4 (66.7)
Primiparity
First infant, n (%)	5 (62.5)	6 (100)	0.472^c
Second infant, n (%)	2 (25.0)	0 (0)
Third infant, n (%)	1 (12.5)	0 (0)
DSM-IV diagnosis (via the structured clinical interview)
Major depressive disorder – onset in postpartum, n (%)	3 (37.5)	2 (33.3)	1,000^c
Major depressive disorder – recurrent episode, n (%)	2 (25)	2 (33.3)
Affective bipolar disorder II – depressive episode in postpartum, n (%)	3 (37.5)	2 (33.3)
Onset of depressive symptoms
Up to 5 days postpartum, n (%)	8 (100)	4 (66.7)	0.164^c
After 1 month postpartum, n (%)	0 (0)	1 (16.7)
Between the 2nd and the 6th month after delivery, n (%)	0 (0)	1 (16.7)
Previous depressive episodes
Yes, n (%)	5 (62.5)	3 (50)	1.000^c
No, n (%)	3 (37.5)	3 (50)
Previous hypomania episodes
Yes, n (%)	1 (12.5)	2 (33.3)	0.538^c
No, n (%)	7 (87.5)	4 (66.7)
Previous psychopharmacological treatment
Yes, n (%)	4 (50)	0 (0)	0.084^c
No, n (%)	4 (50)	6 (100)
Family history
Yes, n (%)	6 (75)	4 (66.7)	1.000^c
No, n (%)	2 (25)	2 (33.3)
Medication in use: clonazepam (1 mg/day), n (%)
Yes, n (%)	3 (37.5)	0 (0)	0.209^c
No, n (%)	5 (62.5)	6 (100)
Baseline rating scale scores
HDRS/17 score	29.13 ± 5.64	26.67 ± 5.68	0.437^a
EPDS score	22.50 ± 3.16	21.50 ± 3.73	0.597^a
HARS/14 score	35.13 ± 8.39	32.83 ± 7.39	0.605^a
CG11 score	4.88 ± 0.35	4.67 ± 0.52	0.365^b
GAS score	38.88 ± 7.70	43.00 ± 7.29	0.331^a
SF-36-vitality score	28.13 ± 17.72	23.33 ± 16.02	0.605^a
SF36-mental health score	22.00 ± 13.86	23.33 ± 20.15	0.885^a

Notes:

a t Student test;

b Wilcoxon–Mann–Whitney test;

c Fisher’s exact test;

* data presented in terms of mean ± standard deviation (SD), unless otherwise specified;

** statistically significant difference, Fisher’s exact test.

Abbreviations: rTMS, repetitive Transcranial Magnetic Stimulation; ABIPEME, Associação Brasileria de Institutos de Pesquisa de Mercado (Association of Marketing Research Firms in Brazil); DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; HDRS/17, 17-item Hamilton Depression Rating Scale; EPDS, Edinburgh Postnatal Depression Scale; HARS/14, 14-item Hamilton Anxiety Rating Scale; CGI, Clinical Global Impression – CGI1-Global Impression of Severity; GAS, Global Assessment Scale; SF-36, Medical Outcomes Study 36-item Short-form Health Survey.

Table 2 Mean scores for clinical, social and neurocognitive measures at baseline (pretreatment), week 4 (end of treatment), and week 6 (follow-up, postreatment week 2), time effect, and interaction to analysis of variance and false discovery rate at baseline versus week 4, week 4 versus week 6, and baseline versus week 6 in active and placebo groups (n = 14)^a

Outcome measures	Weeks	Active group (n = 8) (mean ± SD)	Placebo group (n = 6) (mean ± SD)	Comparing week evaluation	ANOVA (P-values) Within-group^b	FDR (P-values) Within-group^c	ANOVA (P-values) Between-group^b	FDR (P-values) Between-group^c
HDRS/17	Baseline	29.13 ± 5.64	26.67 ± 5.68	Baseline × week 4	0.001*	0.011*	0.109	0.456
	Week 4	18.38 ± 8.68	21.83 ± 8.84	Week 4 × week 6	0.431	0.676	0.211	0.698
	Week 6	18.50 ± 9.83	24.83 ± 7.60	Baseline × week 6	<0.001*	0.001*	0.001**	0.020**
EPDS	Baseline	22.50 ± 3.16	21.50 ± 3.73	Baseline × week 4	0.004*	0.018*	0.099	0.456
	Week 4	12.50 ± 7.45	17.83 ± 8.06	Week 4 × week 6	0.385	0.675	0.594	0.861
	Week 6	13.63 ± 7.84	20.17 ± 7.19	Baseline × week 6	0.001*	0.008*	0.007**	0.069
HARS/14	Baseline	35.13 ± 8.39	32.83 ± 7.39	Baseline × week 4	0.006*	0.022*	0.134	0.505
	Week 4	23.13 ± 11.54	28.50 ± 9.67	Week 4 × week 6	0.333	0.675	0.839	0.972
	Week 6	25.25 ± 12.62	30.67 ± 6.56	Baseline × week 6	0.001*	0.007*	0.012**	0.096
CGI1	Baseline	4.88 ± 0.35	4.67 ± 0.52	Baseline × week 4	0.002*	0.015*	0.108	0.456
	Week 4	3.38 ± 1.19	4.00 ± 1.10	Week 4 × week 6	0.557	0.755	0.299	0.698
	Week 6	3.25 ± 1.39	4.50 ± 0.84	Baseline × week 6	0.001*	0.008*	0.004**	0.047**
CG13	Baseline	6.50 ± 0.53	6.33 ± 0.53	Baseline × week 4	<0.001*	<0.001*	0.893	0.991
	Week 4	3.25 ± 1.39	3.00 ± 0.63	Week 4 × week 6	0.100	0.454	0.159	0.698
	Week 6	3.63 ± 1.69	4.67 ± 0.82	Baseline × week 6	<0.001*	<0.001*	0.038**	0.228
GAS	Baseline	38.88 ± 7.70	43.00 ± 7.29	Baseline × week 4	<0.001*	0.007*	0.025**	0.419
	Week 4	52.75 ± 11.41	47.67 ± 9.87	Week 4 × week 6	0.370	0.675	0.789	0.958
	Week 6	51.38 ± 13.20	45.83 ± 8.66	Baseline × week 6	<0.001*	0.001*	0.002**	0.037**
SF-36-V	Baseline	28.13 ± 17.72	23.33 ± 16.02	Baseline × week 4	0.002*	0.014*	0.184	0.507
	Week 4	52.50 ± 23.90	36.67 ± 21.83	Week 4 × week 6	0.102	0.454	0.220	0.698
	Week 6	50.63 ± 23.82	27.50 ± 19.69	Baseline × week 6	0.012*	0.033*	0.781	0.236
SF-36-MH	Baseline	22.00 ± 13.86	23.33 ± 20.15	Baseline × week 4	0.028*	0.085	0.278	0.556
	Week 4	40.50 ± 18.45	30.67 ± 23.69	Week 4 × week 6	0.890	0.912	0.093	0.698
	Week 6	44.50 ± 22.87	25.33 ± 18.53	Baseline × week 6	0.027*	0.054*	0.054**	0.236
SAS-SR-WH	Baseline	22.00 ± 3.30	17.50 ± 5.75	Baseline × week 4	0.004*	0.018*	0.035**	0.419
	Week 4	16.75 ± 4.74	16.33 ± 6.31	Week 4 × week 6	0.303	0.675	0.064	0.698
	Week 6	15.13 ± 4.94	17.00 ± 6.48	Baseline × week 6	<0.001*	0.003*	0.001**	0.020**
SAS-SR-OSP	Baseline	128.13 ± 14.09	106.00 ± 15.77	Baseline × week 4	0.046*	1.000	0.069	1.000
	Week 4	101.38 ± 28.76	104.50 ± 24.87	Week 4 × week 6	0.177	0.675	0.433	0.792
	Week 6	95.50 ± 32.00	102.00 ± 33.28	Baseline × week 6	0.019*	0.403	0.050**	0.518
VST-Interference	Baseline	36.63 ± 15.33	31.67 ± 12.44	Baseline × week 4	0.091	0.160	0.062	0.419
	Week 4	28.63 ± 10.45	32.17 ± 13.69	Week 4 × week 6	0.043*	0.428	0.780	0.958
	Week 6	25.00 ± 9.88	28.50 ± 12.44	Baseline × week 6	0.002*	0.011*	0.034**	0.228
TMT-B	Baseline	143.38 ± 100.62	92.00 ± 38.09	Baseline × week 4	0.004*	0.018*	0.039**	0.419
	Week 4	100.50 ± 84.84	81.17 ± 33.70	Week 4 × week 6	0.642	0.774	0.708	0.958
	Week 6	98.29 ± 61.03	80.17 ± 30.44	Baseline × week 6	0.017*	0.039*	0.088	0.281

Notes:

a Data presented in terms of mean ± standard deviation;

b analysis performed with repeated-measures;

c post hoc correction False Discovery Rate;

* statistically significant difference, time effect;

** statistically significant difference, group effect.

Abbreviations: HDRS/17, 17 item-Hamilton Depression Rating Scale; EPDS, Edinburgh Postnatal Depression Scale; HARS/14, 14 item-Hamilton Anxiety Rating Scale; CGI1 and 3, Clinical Global Impression – Global Impression of Severity and Quality of Life; GAS, Global Assessment Scale; SF-36-V and SF-36-MH, 36-item Quality of Life Health Survey, Vitality and Mental Health scores; SAS SR-WH and OSP, Social Adjusment Scale-Self Report-Work at Home and Overall Social Performance; TMT-B, Trail Making Part B; VST-Interference, Victoria Stroop Test.

Figure 1 Change in mean values of clinical scales and neuropsychological tests at baseline (pre-treatment), weeks 4 (end of treatment) and 6 (follow up: post-treatment week 2) for active and placebo groups.

Abbreviations: rTMS, repetitive Transcranial Magnetic Stimulation; HDRS/17, 17-item-Hamilton Depression Rating Scale; EPDS, Edinburgh Postnatal Depression Scale; HARS/14, 14 item-Hamilton Anxiety Rating Scale; GAS, Global Assessment Scale; SAS-SR, Social Adjustment Scale-Self Report–Overall Social Performance and Work at Home; Trail Making B and Stroop Test (Interference).