Seeking new solutions for perinatal mental health

Regan Odysseus was scared. She’d tried Prozac before, but the medication made her mental health worse, leaving her unsure whether further treatment would help or hurt. But between her full-time job as an ICU nurse, her full-time job as a mom, and the hormone shifts from her second pregnancy, the pressure on her mental health was becoming unsustainable.

When perinatal psychiatrist Rana Jawish, MD, started a conversation about how Odysseus was doing, she broke down. “It was very enlightening,” Odysseus says. “I didn’t realize I was not in a good place until someone else asked me.”

Jawish was leading a clinical trial to help treat depression and anxiety in pregnant people. When Odysseus learned of the opportunity to participate, she was nervous but determined to try again. “If any time, now is the time,” she recalls thinking, “and I owe it to my children to try to be better for them and feel my best so I can be my best. It was kind of a sense of relief, like, ‘OK, I’m finally going to get this addressed, not just feel like I have to cope with it on my own all the time.'”

An unorthodox strategy

Unlike Odysseus’s previous negative experiences, the clinical trial involved no medication. Instead, the trial used a combination of two strategies: a kind of talk therapy called cognitive behavioral therapy (CBT), combined with regular sessions of transcranial magnetic stimulation (TMS), in which powerful magnetic fields stimulate regions of the brain involved in mood control.

The FDA approved TMS for treatment-resistant depression in nonpregnant populations in 2009. While small pilot studies suggest that TMS could work as a nonpharmacological intervention for depression during pregnancy, it’s still understudied in this population.

Despite being in use for more than a decade, the therapy is still off-label for pregnant people—a population for which nonpharmaceutical mental health treatments are urgently needed, Jawish says.

“According to the Centers for Disease Control and Prevention in 2023, maternal mental health conditions, including depression and substance use disorder, are the most common cause of maternal mortality,” Jawish says. And despite the severity of this issue, treatment options for pregnant people are limited. “A lot of antidepressants have very limited safety data for use while pregnant or breastfeeding,” Jawish adds.

TMS could be an alternative option that wouldn’t involve introducing medications into a pregnant person’s body.

Buzzing your brain

Odysseus’s first TMS appointment was “a little scary,” she recalls. “The magnetic pulse feels like a buzzing sensation in your brain. It’s really weird.” But she says that the comprehensive support of the research team made a big difference. “I felt very supported. They had a whole team there with me, talking me through everything, and I felt really well informed about what to expect from the treatment.”

Odysseus received TMS multiple times a week for six weeks, and she says she noticed real improvements to her mental health. By the end of the trial, “everything became a lot lighter and more tolerable and manageable,” she says. “I felt like a better employee, a better nurse, a better leader, and a better mother.”

While TMS appeared to help Odysseus, the overall efficacy of the therapy for pregnant populations is still unknown. Jawish’s study was designed to test whether TMS combined with CBT is doable for patients and to identify any barriers to completing treatment; with 20 patients, it’s too early to say whether TMS works for most pregnant people. Jawish hopes to start larger clinical studies soon to determine whether the treatment is effective.

From the clinic to communities

Clinical trials like this one are crucial to improving health care for the women she works with every day, Jawish says. “I see my research and clinical practice as synergistic with each other,” she explains. “My clinical practice informs my research question, and my research work advances and improves my clinical practice and the care for my patient.”

She adds that maternal mental health isn’t a niche issue. “This is not women’s mental health. This is community mental health. Because if a mom is not doing well, everyone else in the family is affected.”

Odysseus says that participating in the study felt significant as a means to help develop treatments for pregnant people, regardless of the benefits she personally experienced. “I had better outcomes myself, but then to be able to maybe contribute to other women having better access to better support and better outcomes was meaningful to me. It felt like an important study to participate in.”

To anyone else who may be pregnant and dealing with anxiety or depression, Odysseus adds, “You’re not alone, even if it feels that way. There’s somebody somewhere who’s going through something very similar. It’s OK to ask for help, and it’s really brave. You don’t have to be suffering.”

Who’s behind this story?

Gaby Clark

MA in English, copy editor since 2021 with experience in higher education and health content. Dedicated to trustworthy science news.

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Andrew Zinin

Master’s in physics with research experience. Long-time science news enthusiast. Plays key role in Science X’s editorial success.

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