Clinical TMS Society Statement of Support of Consideration of Transcranial Magnetic Stimulation for Depression During Pregnancy
Major Depression affects 10-15% of women during pregnancy, and it is associated with deleterious outcomes for the mother and child (Vigod et al., 2025). Although antidepressants are recognized treatments for perinatal depression (Vigod et al., 2025), they cross the fetal – placental barrier, which can raise safety concerns (Koo, 2023). Transcranial Magnetic Stimulation (TMS) is an established, non-invasive, safe and effective antidepressant treatment which applies a circumscribed magnetic field to specific cortical brain regions (O’Reardon et al., 2007). TMS has been generally considered to be a safe and acceptable treatment option during pregnancy (Beydler et al., 2025; Koo, 2023; Trapp et al., 2025). A randomized controlled trial, open label studies, meta-analyses, systematic reviews, case series and case studies (Angeline et al., 2025; Cole et al., 2019; Jawish et al., 2024; Kim et al., 2011; Kim et al., 2019; Yee et al., 2022) have investigated the use of TMS during pregnancy. This literature shows effectiveness of TMS with response and remission rates in pregnancy similar to those in the general adult population (Angeline et al., 2025; Hızlı Sayar et al., 2014; Kim et al., 2019; Trapp et al., 2025).
The safety and side effect profile of TMS are similar in pregnant and non- pregnant populations (Cole et al., 2019; Kim et al., 2019; Miuli et al., 2023; Shah et al., 2019; Trapp et al., 2025). Headaches and local pain are commonly reported. Seizure risk with TMS is less than 1% and no seizures have been reported in the literature in pregnant patients. Congenital malformations have not been reported in the offspring of mothers receiving TMS. TMS has been delivered throughout all trimesters of pregnancy without evidence of adverse effects for the fetus or mother (Pridmore et al., 2021). Supine hypotension in advanced pregnancy is a potential risk if TMS is delivered reclined or supine due to mechanical uterine compression of major blood vessels; this can be mitigated with altered positioning. Although preterm births (greater than 35 weeks) have been reported in patients receiving TMS, this obstetric outcome is not different from women receiving placebo/sham TMS. Similarly, neonatal outcomes including fetal growth, APGAR (Appearance, Pulse, Grimace, Activity, Respiration) scores, delivery mode (c-section vs vaginal) and neonatal intensive care unit admission are not different between mothers receiving TMS versus placebo/sham TMS. (Kim et al., 2019, Myczkowsky et al., 2012)
In summary, given the antidepressant efficacy of TMS and its safety in pregnancy, expectant mothers should not be precluded from this treatment. TMS should be considered as an antidepressant treatment option weighing the risks of the treatment against the risks of untreated illness. For this patient population interdisciplinary collaboration with obstetricians is recommended to weigh any concomitant health issues affecting pregnancy. Clinicians administering TMS should adhere to all clinical standards delineated by the CTMSS in the published Consensus review of TMS to treat depression.
References
Angeline, S., Tiyatiye, B., & Akosile, W. (2025). Transcranial Magnetic Stimulation in Pregnancy: Efficacy, Safety, and Future Implications for Perinatal Mental Health Care. Brain Behav, 15(2), e70304. https://doi.org/10.1002/brb3.70304
Beydler, E. M., Koire, A., Steuber, E., Taylor, J. J., & Mergler, R. J. (2025). Rapid-Acting Treatments for Perinatal Depression: Clinical Landscapes and Future Horizons. Int J Environ Res Public Health, 22(4). https://doi.org/10.3390/ijerph22040546
Cole, J., Bright, K., Gagnon, L., & McGirr, A. (2019). A systematic review of the safety and effectiveness of repetitive transcranial magnetic stimulation in the treatment of peripartum depression. J Psychiatr Res, 115, 142-150. https://doi.org/10.1016/j.jpsychires.2019.05.015
Hızlı Sayar, G., Ozten, E., Tufan, E., Cerit, C., Kağan, G., Dilbaz, N., & Tarhan, N. (2014).
Transcranial magnetic stimulation during pregnancy. Arch Womens Ment Health, 17(4), 311-315. https://doi.org/10.1007/s00737-013-0397-0
Jawish, R., Smid, M., Gordon, A., Shangraw, K., & Mickey, B. J. (2024). Prolonged transcranial magnetic stimulation in a pregnant patient with treatment-resistant depression: a case report. J Med Case Rep, 18(1), 512. https://doi.org/10.1186/s13256-024-04855-y
Kim, D. R., Epperson, N., Paré, E., Gonzalez, J. M., Parry, S., Thase, M. E., Cristancho, P., Sammel, M. D., & O’Reardon, J. P. (2011). An open label pilot study of transcranial magnetic stimulation for pregnant women with major depressive disorder. J Womens Health (Larchmt), 20(2), 255-261. https://doi.org/10.1089/jwh.2010.2353
Kim, D. R., Wang, E., McGeehan, B., Snell, J., Ewing, G., Iannelli, C., O’Reardon, J. P., Sammel, M. D., & Epperson, C. N. (2019). Randomized controlled trial of transcranial magnetic stimulation in pregnant women with major depressive disorder. Brain Stimul, 12(1), 96-102. https://doi.org/10.1016/j.brs.2018.09.005
Koo, M. (2023). The potential of transcranial magnetic stimulation as a treatment for depression during pregnancy. Brain Stimul, 16(3), 734-736. https://doi.org/10.1016/j.brs.2023.04.005
Miuli, A., Pettorruso, M., Stefanelli, G., Giovannetti, G., Cavallotto, C., Susini, O., Pasino, A., Bubbico, G., De Risio, L., Petta, G. D., Sensi, S. L., D’Antonio, F., & Martinotti, G. (2023). Beyond the efficacy of transcranial magnetic stimulation in peripartum depression: A systematic review exploring perinatal safety for newborns. Psychiatry Res, 326, 115251. https://doi.org/10.1016/j.psychres.2023.115251
O’Reardon, J. P., Solvason, H. B., Janicak, P. G., Sampson, S., Isenberg, K. E., Nahas, Z.,
McDonald, W. M., Avery, D., Fitzgerald, P. B., Loo, C., Demitrack, M. A., George, M. S., & Sackeim, H. A. (2007). Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry, 62(11), 1208-1216. https://doi.org/10.1016/j.biopsych.2007.01.018
Pridmore S, Turnier-Shea Y, Rybak M, Pridmore W. Transcranial Magnetic Stimulation (TMS) during pregnancy: a fetal risk factor. Australas Psychiatry. 2021
Apr;29(2):226-229. doi: 10.1177/1039856221992636. Epub 2021 Mar 2. PMID: 33653123.
Shah, M. R., Jampa, A., Kaur, M., Robert, C. A., & Patel, R. S. (2019). Transcranial Magnetic Stimulation for Major Depressive Disorder in Pregnancy: A Literature Review. Cureus, 11(8), e5431. https://doi.org/10.7759/cureus.5431
Trapp, N. T., Purgianto, A., Taylor, J. J., Singh, M. K., Oberman, L. M., Mickey, B. J., Youssef, N. A., Solzbacher, D., Zebley, B., Cabrera, L. Y., Conroy, S., Cristancho, M., Richards, J. R., Flood, M. J., Barbour, T., Blumberger, D. M., Taylor, S. F., Feifel, D., Reti, I. M., . . .
Husain, M. M. (2025). Consensus review and considerations on TMS to treat depression: A comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology. Clin Neurophysiol, 170, 206-233. https://doi.org/10.1016/j.clinph.2024.12.015
Vigod, S. N., Frey, B. N., Clark, C. T., Grigoriadis, S., Barker, L. C., Brown, H. K., Charlebois, J., Dennis, C. L., Fairbrother, N., Green, S. M., Letourneau, N. L., Oberlander, T. F., Sharma, V., Singla, D. R., Stewart, D. E., Tomasi, P., Ellington, B. D., Fleury, C., Tarasoff,
- A., . . . Van Lieshout, R. J. (2025). Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l’humeur, des troubles anxieux et des troubles connexes périnatals. Can J Psychiatry, 70(6), 429-489. https://doi.org/10.1177/07067437241303031
Yee, A., Pedersen, E., & Koo, M. (2022). A case series of repetitive transcranial magnetic stimulation in the treatment of major depression during pregnancy. Brain Stimul, 15(2), 373-375.