CNSPulse

INTEGRATING COGNITIVE-BEHAVIORAL THERAPY WITH REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (CBT/TMS): A NOVEL COMBINED NEUROMODULATION-PSYCHOTHERAPY MODEL FOR PRENATAL DEPRESSION

Rana Jawish — University of Utah School of Medicine Individual

2026 ASCP Annual Meeting

Background

Perinatal depression affects approximately 11.5% of pregnant individuals, with up to 1 in 7 women experiencing depressive symptoms during pregnancy. Despite its prevalence, 50–70% of cases go undiagnosed and nearly 85% untreated in the United States. Untreated prenatal depression is associated with preterm birth, low birth weight, congenital anomalies, and increased maternal risk of hypertension, preeclampsia, and gestational diabetes. A key transdiagnostic process within perinatal depression is repetitive negative thinking (RNT)/rumination, which predicts impaired maternal–fetal attachment, greater late-pregnancy depression and anxiety, and increased postpartum psychopathology. Rumination is linked to dysregulated activity in the default mode network (DMN)—particularly the PCC and vmPFC—as well as altered cognitive control network (CCN) functioning. Disrupted DMN–CCN connectivity is associated with impaired inhibitory control and heightened negative affect. Both rTMS and ruminationfocused CBT (RF-CBT) independently modulate these neural networks: rTMS alters DLPFC–ACC connectivity, while RF-CBT changes medial PFC–ACC and fronto-limbic circuitry. Prior adult studies combining CBT with TMS demonstrate 66% response and 56% remission with sustained effect at follow-up. Emerging data support the safety and efficacy of TMS in pregnancy, with clinical trials, open-label studies, and case series—including Jawish et al. (2024)—demonstrating symptom improvement without major maternal or fetal adverse outcomes.

Objective

This pilot study is the first to evaluate whether augmenting perinatal TMS with RF-CBT enhances antidepressant response and modulates neurocircuitry underlying rumination. We hypothesize synergistic effects on depressive symptoms, rumination severity, DMN–CCN connectivity, and functional outcomes.

Methods

Pregnant individuals with moderate–severe MDD receive protocolized left-DLPFC rTMS combined with weekly RF-CBT. Outcomes include QIDS/EPDS change, WHODAS functioning, rumination indices, and exploratory fMRI.

Conclusion

Integrating TMS with RF-CBT may represent a novel, mechanism-informed, multimodal treatment for perinatal depression—targeting both symptoms and

References

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