title: Neuromodulation and antenatal depression: a review.
abstract: BACKGROUND
  Depression during pregnancy affects 5%-8% of women. While the percentage of women in the US taking serotonin reuptake inhibitors during pregnancy has risen over the last decade, pregnant women continue to report that they prefer non-pharmacologic interventions.
  
  
  OBJECTIVE
  We review the literature regarding neuromodulation techniques for major depressive disorder during pregnancy. The rationale for their use in this population, new developments, and future directions are discussed.
  
  
  METHODS
  A literature search was conducted in PubMed Plus, Ovid Medline, and Embase to collect all articles on neuromodulation for the treatment of depression during pregnancy. Key search words included electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation, transcranial direct current stimulation, neuromodulation, depression, and pregnancy. Given the sparse literature, all articles from 1960 to 2014 that addressed the use of neuromodulation in pregnancy were included.
  
  
  CONCLUSIONS
  The data support the use of electroconvulsive therapy in all trimesters of pregnancy for major depressive disorder. New data are emerging for the use of transcranial magnetic stimulation in pregnancy, which is likely safe, but more data are needed before it can be recommended as a primary treatment modality during pregnancy. Other neuromodulation techniques have not been well studied in this population.
authors.affiliation: Department of Psychiatry, Penn Center for Women's Behavioral Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Penn Center for Women's Behavioral Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Snell
authors.affiliation: Department of Psychiatry, Penn Center for Women's Behavioral Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Grace C
authors.initials: GC
authors.lastname: Ewing
authors.affiliation: Department of Psychiatry, Rowan University, Rowan School of Medicine, Cherry Hill, NJ, USA.
authors.forename: John
authors.initials: J
authors.lastname: O'Reardon
keywords: antenatal depression; depression; electroconvulsive therapy; perinatal; pregnancy; transcranial magnetic stimulation