Nota clínica: Efecto antidepresivo de la EMTr durante el embarazo en un caso de Depresión Mayor Resistente al Tratamiento Farmacológico.

Antidepressant effect r TMS during pregnancy in a case of Major Depression Resistant to Pharmacological Treatment.

TRANSCRANIAL magnetic stimulation; MENTAL depression; PREGNANT women; PHYSIOLOGICAL effects of antidepressants; BIPOLAR disorder; DRUG therapy; NEWBORN infants

El trastorno depresivo mayor (TDM) constituye una complicación común del embarazo y el período posparto. Aproximadamente un 5% de mujeres que presentan un TDM durante la gestación o el periodo postparto cumplen criterios para depresión resistente, asociándose con un incremento de la morbilidad tanto en el recién nacido como en la propia gestante. En la actualidad disponemos de diferentes opciones terapéuticas para el tratamiento del TDM durante el embarazo si bien en los casos de resistencia durante el embarazo los criterios de tratamiento no se encuentran tan bien establecidos. Presentamos el caso de una mujer de 36 años de edad que desarrolló un episodio de depresión mayor resistente al tratamiento farmacológico. Durante el episodio actual y tras cuatro ciclos de tratamiento farmacológico fallido se quedó embarazada. A las 16 semanas de gestación fue tratada con estimulación magnética transcraneal repetitiva (EMTr) de baja frecuencia. Tras 30 sesiones de tratamiento, con buena tolerancia, la paciente presentó una recuperación completa de la sintomatología depresiva, dando a luz a un recién nacido sano. La EMTr constituye una buena alternativa frente a la Terapia Electroconvulsiva en algunos casos de TDM resistente durante la gestación. A pesar de estos hallazgos prometedores, se requiere de un mayor número de estudios controlados, doble ciego que incluyan muestras amplias de pacientes embarazadas, con parámetros EMTr bien diseñados, e incluso estudios prospectivos (siguiendo a mujeres embarazadas y sus descendientes) para confirmar la ausencia de efectos secundarios a largo plazo. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) is a common complication of pregnancy and the postpartum period. Approximately 5% of women who have MDD during pregnancy or the postpartum period meet criteria for resistant depression, associated with increased morbidity in both the newborn and the pregnant woman. Currently we have different therapeutic options for the treatment of MDD during pregnancy, although in cases of resistance during that period the treatment criteria are not that well established. We set out the case of a 36-year-old woman who presents an episode of major depression resistant to pharmacotherapy. During the current episode and after four cycles of failed pharmacological treatment she became pregnant. In the 16th week of gestation, she was treated with low-frequency repetitive transcranial magnetic stimulation (rTMS). After 30 treatment sessions, with good tolerance, the patient presented a complete recovery from the depressive symptoms, giving birth to a healthy newborn. rTMS is a good alternative to Electroconvulsive Therapy in some cases of resistant MDD during pregnancy. Despite these promising findings, further double-blind controlled studies with broad samples of pregnant women are required, with well-designed rTMS parameters, and even prospective studies (following pregnant women and their offspring) to confirm the absence of long-term side effects. [ABSTRACT FROM AUTHOR]

Copyright of Actas Espanolas de Psiquiatria is the property of IRM Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)