{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T06:26:44Z","timestamp":1768458404994,"version":"3.49.0"},"reference-count":15,"publisher":"FapUNIFESP (SciELO)","issue":"4","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  OBJECTIVE: Postpartum depression significantly affects maternal mental health and family dynamics. Effective and safe treatments are crucial to enhance the quality of life for affected women. This study assesses the effectiveness and safety of combining sertraline with repetitive transcranial magnetic stimulation in treating postpartum depression.  METHODS: We recruited 152 postpartum depression patients at West China Hospital between May 2020 and October 2023, dividing them into sertraline-only (n=61) and combined treatment (n=91) groups. We evaluated treatment outcomes after 8 weeks, comparing effectiveness, quality of life, neurotransmitter levels, and estrogen levels, while monitoring for adverse reactions.  RESULTS: After 8 weeks, the combined treatment group exhibited a significantly higher effectiveness rate (95.6%) compared to the sertraline-only group (78.7%; p=0.001). Factors such as age, marital status, and treatment regimen significantly influenced treatment outcomes, with women under 30 and married women showing superior results. Post-treatment, both groups showed improvements in physical, psychological, social, and environmental aspects of life, with the combined group achieving notably higher scores. Improvements in neurotransmitter levels (5-hydroxytryptamine and plasma norepinephrine) and hormonal balances (luteinizing hormone, follicle-stimulating hormone, progesterone, and estradiol) were more substantial in the combined treatment group. Both groups had similar rates of adverse reactions, indicating that combining treatments did not significantly increase adverse events (11.0% in the combined group vs. 4.9% in the sertraline group; p=0.190).  CONCLUSIONS: Combining sertraline with repetitive transcranial magnetic stimulation significantly enhances treatment effectiveness and improves neurotransmitter and hormone levels, contributing to better quality of life outcomes for postpartum depression patients without increasing adverse reactions.<\/jats:p>","DOI":"10.1590\/1806-9282.20241001","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T11:05:33Z","timestamp":1748862333000},"source":"Crossref","is-referenced-by-count":2,"title":["Sertraline plus repetitive transcranial magnetic stimulation for the treatment of postpartum depression"],"prefix":"10.1590","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4112-3958","authenticated-orcid":false,"given":"Zhengyu","family":"Zhang","sequence":"first","affiliation":[{"name":"Sichuan University,  China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6995-9223","authenticated-orcid":false,"given":"Ting","family":"Luo","sequence":"additional","affiliation":[{"name":"Sichuan University,  China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5930-7397","authenticated-orcid":false,"given":"Jianying","family":"Yu","sequence":"additional","affiliation":[{"name":"Sichuan University,  China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2025]]},"reference":[{"issue":"3","key":"ref1","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.ogc.2020.05.001","article-title":"Postpartum depression: identification and treatment in the clinic setting","volume":"47","author":"Kroska EB","year":"2020","journal-title":"Obstet Gynecol Clin North Am"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.jad.2018.10.361","article-title":"A placebo controlled treatment trial of sertraline and interpersonal psychotherapy for postpartum depression","volume":"245","author":"O\u2019Hara MW","year":"2019","journal-title":"J Affect Disord"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jad.2019.11.069","article-title":"Repetitive transcranial magnetic stimulation for the treatment of postpartum depression","volume":"264","author":"Cox EQ","year":"2020","journal-title":"J Affect Disord"},{"issue":"2","key":"ref4","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.clinph.2019.11.002","article-title":"Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014-2018)","volume":"131","author":"Lefaucheur JP","year":"2020","journal-title":"Clin Neurophysiol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/j.jad.2021.01.012","article-title":"Prevalence and risk factors of postpartum depression in China: a hospital-based cross-sectional study","volume":"282","author":"Peng S","year":"2021","journal-title":"J Affect Disord"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"102873","DOI":"10.1016\/j.ajp.2021.102873","article-title":"Sensitivity to change and minimal clinically important difference of Edinburgh postnatal depression scale","volume":"66","author":"Mao F","year":"2021","journal-title":"Asian J Psychiatr"},{"issue":"4","key":"ref7","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1080\/0167482X.2022.2052845","article-title":"Symptomatology in 1,112 women screened positive and negative using the Edinburgh postnatal depression scale (EPDS): longitudinal observations from the first trimester to 6 weeks postpartum of a Chinese cohort","volume":"43","author":"Liu L","year":"2022","journal-title":"J Psychosom Obstet Gynaecol"},{"issue":"5","key":"ref8","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/j.brs.2017.07.002","article-title":"Functional connectivity of the left DLPFC to striatum predicts treatment response of depression to TMS","volume":"10","author":"Avissar M","year":"2017","journal-title":"Brain Stimul"},{"issue":"1","key":"ref9","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s12884-021-03600-3","article-title":"Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis","volume":"21","author":"Lee HJ","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"457","DOI":"10.3389\/fphys.2017.00457","article-title":"Mechanism of action for rTMS: a working hypothesis based on animal studies","volume":"8","author":"Soundara Rajan T","year":"2017","journal-title":"Front Physiol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.jpsychires.2019.05.015","article-title":"A systematic review of the safety and effectiveness of repetitive transcranial magnetic stimulation in the treatment of peripartum depression","volume":"115","author":"Cole J","year":"2019","journal-title":"J Psychiatr Res"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.psychres.2019.05.042","article-title":"Efficacy of rTMS in decreasing postnatal depression symptoms: a systematic review","volume":"279","author":"Ganho-\u00c1vila A","year":"2019","journal-title":"Psychiatry Res"},{"issue":"1","key":"ref13","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.brs.2009.06.001","article-title":"Repetitive transcranial magnetic stimulation treats postpartum depression","volume":"3","author":"Garcia KS","year":"2010","journal-title":"Brain Stimul"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.yfrne.2018.12.001","article-title":"Pathophysiological mechanisms implicated in postpartum depression","volume":"52","author":"Payne JL","year":"2019","journal-title":"Front Neuroendocrinol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1146\/annurev-med-041217-011106","article-title":"Postpartum depression: pathophysiology, treatment, and emerging therapeutics","volume":"70","author":"Stewart DE","year":"2019","journal-title":"Annu Rev Med"}],"container-title":["Revista da Associa\u00e7\u00e3o M\u00e9dica 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