Magnetic pulses to the brain: a Drug-Free hope for peripartum depression?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Women aged 18 years or older * Currently pregnant or up to 12 months after childbirth at screening * Current depressive episode or clinically significant depressive symptoms consistent with peripartum depression, confirmed by clinical interview according to ICD-10 criteria * MADRS score of at least 7 at screening * Able to understand German or English * Able to provide written informed consent * Willing and able to attend study visits and complete rTMS procedures, EEG and ECG recordings, hair and sputum sampling, and study questionnaires * Stable antidepressant and/or psychotherapy treatment, or no current antidepressant medication and/or psychotherapy; participants should agree to maintain treatment stability during the study where clinically feasible * Previous rTMS treatment for depression is permitted Exclusion Criteria: * Current or past seizure disorder, or previous rTMS-induced seizure * Primary psychotic disorder * Acute suicidality requiring a higher level of care * Contraindications to rTMS, including intracranial metallic implants; implanted neurostimulators; cochlear implants; vagus nerve stimulators; ocular implants; implanted cardiac electrodes or pacemakers; aneurysm coils or clips; ventriculo-peritoneal shunts; or other ferromagnetic or electronic implants in the head or neck * Clinically significant head injury within the previous 12 months or with relevant residual symptoms * Unstable or severe medical or obstetric complications that could make participation unsafe, such as preeclampsia or imminent preterm labour requiring intensive management * Severe substance use disorder that could interfere with safety or study assessments * Inability to follow study procedures, for example because of cognitive impairment * Frequent severe migraine, including chronic migraine with status migrainosus, if high-frequency rTMS is considered likely to worsen symptoms, unless the investigator and treating physician determine that participation is safe.