TMS is used during pregnancy and after birth, but it is not FDA-cleared specifically for either, and the evidence is limited. FDA's device guidance lists people who are "pregnant or nursing" among groups with a lack of evidence for efficacy or safety; that is a precaution, not a ban. The research consists of one small sham-controlled trial in pregnancy and about 230 treated pregnancies, mostly in uncontrolled studies, and a 2026 systematic review describes TMS for perinatal depression as "experimental."
The appeal is real: TMS acts on the brain without a medicine circulating through the body, so there is no drug exposure for the baby. That is why perinatal psychiatrists take it seriously. But "no drug" is not the same as "proven safe"; the 2026 review notes that safety data cover only about 230 pregnancies, and any decision should weigh the risks of untreated depression against what is and is not known.
If you are thinking about suicide or are in crisis, call or text 988 (the 988 Suicide & Crisis Lifeline) or go to the nearest emergency room.
Why TMS interests perinatal psychiatry
Depression in pregnancy and after birth is common and serious, and untreated depression carries its own risks for parent and baby. Antidepressants are an important and often appropriate option, and many people take them safely during pregnancy and breastfeeding; this guide to psychiatric medication during pregnancy covers that side. Still, some people cannot tolerate medication, have not responded to it, or strongly prefer to avoid it.
TMS stands out for three reasons. The magnetic field is focused on a small area of the scalp and fades quickly with distance. Nothing is swallowed or injected, so nothing enters the bloodstream or breast milk. And sessions do not need anesthesia, unlike ECT. The international safety guideline for TMS (IFCN, 2021) concludes that the physics of conventional rTMS "appear compatible with pregnancy," and that the main risk to the fetus would be a seizure in the mother caused by TMS, which is rare.
What the studies actually show
| Study or review | What it was | What it found |
|---|---|---|
| Kim et al., 2019 | Randomized, sham-controlled; 22 pregnant women in the second or third trimester; low-frequency (1 Hz) right-sided TMS, 20 sessions | Symptoms fell significantly more with active TMS; response and remission differences were not statistically significant; 3 late preterm births, all in the active group |
| Child follow-up cited by IFCN | 26 children aged 18 to 62 months whose mothers had high-frequency TMS in pregnancy | No increase in perinatal complications; normal cognitive and motor development, comparable to children of mothers with untreated depression |
| IFCN case summary | 12 published reports, 50 pregnant patients | Side effects "transient, mild, and usually limited to scalp pain and mild headache" |
| Miuli et al., 2023 | Systematic review of 23 studies (2 randomized) | Called TMS for peripartum depression "safe, feasible and well-tolerated" for the fetus and newborn |
| Khalesi et al., 2026 | Systematic review | Efficacy evidence very low certainty; safety data cover about 230 pregnancies; TMS here "remains experimental" |
| Postpartum study, 2026 | 120 women with mild postpartum depression; TMS plus usual care vs usual care; not randomized, no sham | Greater improvement with TMS; authors say sham-controlled trials are needed |
Two reviews looking at much the same literature reached different tones. The 2023 review emphasized reassurance; the 2026 review stressed that "absence of observed harm is not equivalent to evidence of safety." Both are fair readings of a small evidence base, and you deserve to hear both.
What is still unknown
- Whether TMS works better than sham in pregnancy. The one sham-controlled trial had 22 participants, and its response and remission differences were not statistically significant.
- Preterm birth. The three late preterm births in the active group of that trial may be chance, but the authors say a link cannot be excluded without larger trials.
- Deep TMS. Most pregnancy data come from figure-8 coils. IFCN notes that safety data for the H-coil used in deep TMS during pregnancy "are not yet available."
- Newer protocols. Accelerated schedules such as SAINT have not been cleared for postpartum depression; the manufacturer described postpartum depression as an indication still in trials as of early 2026.
- Long-term child outcomes. Follow-up so far covers small numbers of children over a few years.
Device manufacturers reflect the same caution. NeuroStar's instructions for use list patients who are "pregnant or nursing" among groups in which safety and effectiveness have not been established, and ask clinics to report any pregnancy during or soon after treatment.
After birth and while breastfeeding
Postpartum depression is not the same as the baby blues, which usually pass within a couple of weeks; if you are not sure which you are dealing with, read baby blues vs postpartum depression. Once a baby is born, the fetal questions fall away, and the decision looks more like any adult's decision about TMS for depression, with two additions.
First, breastfeeding. Because TMS involves no medication, there is no drug to pass into breast milk, and there is no known reason to pump and discard after a session. FDA's guidance still lists nursing among populations without dedicated evidence, so it is a precaution to discuss rather than a reason to stop nursing. For the medication side of this question, see breastfeeding and psychiatric medications.
Second, logistics. A standard course means daily visits for about six weeks, which is hard with a newborn. Ask whether a partner or relative can come along or cover childcare, and see fitting daily TMS sessions into a Brooklyn week for practical planning.
There is also a medication specifically for postpartum depression. In August 2023, FDA approved zuranolone (Zurzuvae), the first oral medication indicated for postpartum depression in adults, taken once daily for 14 days. It does involve drug exposure and has its own precautions, so it belongs in the same conversation rather than replacing it.
Where TMS fits among perinatal options
For most people with perinatal depression, the first steps are psychotherapy, such as cognitive behavioral or interpersonal therapy, and, when needed, an antidepressant chosen with pregnancy or breastfeeding in mind. This piece on CBT for postpartum depression is a useful starting point. TMS is usually considered when those have not worked or are not tolerated, or in specialist settings with experience in perinatal care.
Situations where TMS is generally not the right step include depression with psychosis, severe suicidal thinking, or postpartum mania. Expert consensus advises that people with psychotic symptoms or acute suicidal ideation be considered for treatments with more established efficacy, such as ECT. Bipolar disorder also needs careful assessment, as FDA lists it among populations with a lack of evidence for TMS. For a broader view of how TMS compares with other options, see TMS or another antidepressant.
What a course would look like if you go ahead
The sessions themselves are the same as for anyone with depression. You sit in a reclining chair, awake, with earplugs in; FDA guidance requires hearing protection rated at 30 dB of noise reduction because the coil clicks loudly. At the first visit the team finds your motor threshold, the strength needed to make your fingers twitch, and uses it to set the dose. A standard course is daily sessions, five days a week, for about six weeks, often followed by a short taper.
A few things are worth arranging specifically for pregnancy:
- Ask that your obstetric team receive a short note before the first session and a summary at the end.
- Agree in advance who to call if you have bleeding, contractions, reduced fetal movement or other pregnancy symptoms, so a TMS visit never delays obstetric care.
- Ask about seating and breaks as your pregnancy progresses; sitting still for the session is easier with good support.
- Protect sleep as much as you can, and tell the team about any illness, fever or new medication, since these can lower the seizure threshold.
For a session-by-session picture, read what TMS therapy is.
When to get urgent help instead
Some perinatal symptoms need same-day care, not a referral for TMS. Seek urgent help if you or your partner notice confusion, seeing or hearing things others do not, not sleeping for days while feeling unusually energized, intrusive thoughts of harming yourself or the baby that feel like urges rather than unwanted worries, or feeling unable to keep yourself or your baby safe. These can be signs of postpartum psychosis or a severe episode, which need immediate assessment.
Making the decision together
A good decision here is shared between you, your psychiatrist and your obstetric team. Questions worth working through:
- How severe is the depression now, and what are the risks of waiting or leaving it untreated?
- What has been tried, at what dose and for how long?
- Is my obstetrician or midwife aware and comfortable, and how will they be kept informed?
- Which coil and protocol would be used, and what pregnancy data exist for that approach specifically?
- How will seizure risk be minimized? (Sleep loss is a known risk factor, which matters with a newborn.)
- How will progress be measured, and when will we stop if it is not helping?
- Will this be an off-label decision, and what will it cost if insurance declines?
Standard TMS screening still applies, including questions about metal in the head and seizure history; see am I a candidate for TMS and TMS side effects. Partners can help a great deal; the guide to supporting a loved one through TMS is a good share.
For perinatal mental health care more broadly, see the practice's postpartum and perinatal mental health treatment. The TMS guide covers the rest of the TMS topics, and the TMS therapy page explains how to start a conversation about whether TMS is an option for you.
Sources
- Class II Special Controls Guidance Document: Repetitive Transcranial Magnetic Stimulation (rTMS) Systems. U.S. Food and Drug Administration, 2011. fda.gov
- Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clinical Neurophysiology (Rossi et al., IFCN), 2021. europepmc.org
- Randomized controlled trial of transcranial magnetic stimulation in pregnant women with major depressive disorder. Brain Stimulation (Kim et al.), 2019. europepmc.org
- Beyond the efficacy of transcranial magnetic stimulation in peripartum depression: A systematic review exploring perinatal safety for newborns. Psychiatry Research (Miuli et al.), 2023. europepmc.org
- Digital and repetitive transcranial magnetic stimulation interventions for perinatal depression and anxiety: a systematic review. BMC Psychiatry (Khalesi et al.), 2026. europepmc.org
- Efficacy of repetitive transcranial magnetic stimulation for mild postpartum depression and its association with changes in plasma neuropeptide levels: a prospective, non-randomized controlled study. Frontiers in Psychiatry, 2026. europepmc.org
- 510(k) K220177 and 510(k) Summary, Magnus Neuromodulation System with SAINT Technology. U.S. Food and Drug Administration, 2022. accessdata.fda.gov
- NeuroStar System Instructions for Use (52-4US1E-030 Rev. F). Neuronetics, 2021. neurostar.com
- FDA Approves First Oral Treatment for Postpartum Depression. U.S. Food and Drug Administration, 2023. fda.gov
- 510(k) K231926 and 510(k) Summary, NeuroStar Advanced Therapy System. U.S. Food and Drug Administration, 2024. accessdata.fda.gov
- Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. Journal of Clinical Psychiatry (McClintock et al.), 2018. pmc.ncbi.nlm.nih.gov
FAQs
Is TMS safe during pregnancy?
No serious problems have been found in the small number of pregnancies studied, and an international safety guideline cautiously concludes it is minimal risk for mother and child, based mostly on figure-8 coil data. But the evidence is limited, and one small trial saw three late preterm births in the active group, so it is a decision to weigh carefully.
Is TMS FDA-cleared for postpartum depression?
No device is cleared specifically for postpartum depression. TMS for depression after birth falls under general adult depression labeling, and FDA guidance lists nursing as a population without dedicated evidence.
Can I breastfeed while having TMS?
TMS involves no medication, so nothing passes into breast milk. FDA guidance lists nursing as a precaution because it has not been specifically studied, so discuss it with your psychiatrist.
Which trimester is TMS used in?
The one sham-controlled trial treated women in the second and third trimesters. Data on first-trimester treatment are more limited.
Is TMS better than antidepressants in pregnancy?
There is no head-to-head evidence. Antidepressants have far more pregnancy data. TMS avoids drug exposure but has much less research behind it, so the right choice depends on your history and preferences.
