Patient perspectives on barriers to rTMS for peripartum depression

Peripartum depression (PPD) is often underdiagnosed and left untreated. PPD can negatively impact maternal health and child development and is associated with an increased risk of maternal suicide. Effective and safe treatments that are viewed as acceptable by patients are needed. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulatory treatment that has the potential to meet this need.

The objective was to identify the level of awareness of rTMS among participants who experienced depressive symptoms during the peripartum period and to understand the barriers and facilitators that impact access to rTMS. Three focus groups with a total of 9 participants who experienced depressive symptoms during the peripartum period were conducted. A descriptive interpretive thematic analysis was completed.

The majority of participants (6 out of 9; 67%) never heard of rTMS prior to this study. Following a brief description of rTMS by the researcher, all participants expressed an interest in rTMS and a willingness to learn more about it as a treatment for PPD; however, some expressed reservations about receiving the treatment during pregnancy due to uncertainty regarding whether it could have an impact on their child's well-being. The following four themes were identified as the primary factors that impact access to rTMS: limited awareness of rTMS's existence, financial challenges, physical accessibility, and weighing the pros and cons of medication vs. rTMS.

Increasing the general public's and their health providers' awareness regarding rTMS and other novel treatments is a crucial step toward improving access to care. Greater awareness of rTMS for PPD may support earlier recognition of appropriate candidates, improve referral pathways, and reduce barriers related to knowledge, accessibility, and treatment hesitancy. Further research is needed to continue evaluating the safety, effectiveness, and accessibility of rTMS for PPD.