Prevention and early intervention strategies for perinatal mental health disorders mediated by neuroimmune modulation and anti-inflammatory mechanisms through non-invasive transcranial magnetic stimulation: A narrative review

Abstract

Perinatal mental health disorders, including postpartum depression (PPD), affect approximately 20 % of females during pregnancy and the postpartum period; however, are often undiagnosed and untreated. Traditional treatments, such as antidepressants, have limitations, particularly in terms of safety and efficacy during pregnancy. Recent advancements in brain stimulation therapies, such as repetitive transcranial magnetic stimulation (rTMS), offer promising non-invasive alternatives that may be safer and more effective in treating PPD. rTMS therapy uses magnetic pulses to stimulate the brain areas associated with psychiatric disorders without systemic side effects or the need for anesthesia, making it safe for pregnant patients. This review aims to provide a narrative overview of the potential of rTMS neuromodulation from a neuroimmune–neuroendocrine–neuroinflammatory perspective with a focus on perinatal depression. rTMS exerts its antidepressant effects by indirectly modulating neuroimmune and anti-inflammatory processes, with few maternal side effects and no fetal risks, as is common with pharmacotherapy. Perinatal mental health disorders may arise from abnormalities in the inflammatory and immune system homeostasis, which are influenced by hormonal changes during the perinatal period. Neuroinflammation, driven by cytokines and immune cells crossing the blood–brain barrier, plays a significant role. The interaction between the central and peripheral nervous systems is crucial for neuroinflammation and immune responses. The neurotransmitters produced by neurons and immune cells regulate the immune responses and inflammation, emphasizing the importance of neuroendocrine–immune system interactions. Immune-mediated inflammatory diseases cause chronic inflammation due to the dysregulation of the immune response, affecting the central nervous system in conditions such as perinatal depression or long COVID (post-COVID-19 syndrome). rTMS therapy can potentially reduce or ameliorate the pathophysiology of neurological and neuropsychiatric disorders by modulating the neuroimmune interactions, reducing inflammation, and promoting neuronal protection and repair, thereby highlighting its potential for managing neuroinflammation and related symptoms.