Coimbra team studies innovative treatment for peripartum depression in Portugal

A research team led by the University of Coimbra (UC) is studying the feasibility and acceptability of a non-invasive, non-pharmacological treatment for depression during pregnancy and the postnatal period in Portugal. With this intervention, which has already proven effective in studies conducted in other countries, the researchers aim to make available in Portugal a treatment that can be easily accessed by more women experiencing depression during pregnancy or after childbirth.

The treatment combines low-intensity transcranial direct current stimulation (tDCS) with a cognitive-behavioural psychological intervention delivered through a mobile application. It will be made available for the first time in Portugal at the Local Health Unit of Coimbra (ULS de Coimbra), specifically at Maternidade Bissaya Barreto.

More specifically, “the treatment lasts ten weeks: during the first three weeks, the patient attends five sessions per week, and in the following seven weeks, they attend three sessions per week. Each session includes 30 minutes of brain stimulation combined with a set of exercises delivered through the app, integrated into a brief cognitive-behavioural psychological intervention,” explains Ana Ganho Ávila, lecturer at the Faculty of Psychology and Educational Sciences of the University of Coimbra and researcher at the Centre for Research in Neuropsychology and Cognitive-Behavioural Intervention (CINEICC).

Specifically, “the treatment lasts ten weeks: during the first three weeks, participants complete five sessions per week (one per day), followed by three sessions per week over the subsequent seven weeks. Each session includes 30 minutes of brain stimulation combined with a set of exercises delivered through the app, integrated into a brief cognitive-behavioural psychological intervention,” explains Ana Ganho Ávila, professor at the Faculty of Psychology and Educational Sciences of the University of Coimbra and researcher at the Centre for Research in Neuropsychology and Cognitive‑Behavioural Intervention (CINEICC).

Regarding the electrical stimulation component, the researcher explains that “tDCS is a non-invasive and non-pharmacological technique that enables neuromodulation by making specific areas of the brain more or less excitable. It acts directly on neuronal function and is a safe, painless technique when used under medical supervision. Stimulation sessions can target specific brain regions, making this a practical way of influencing brain function and leading to improvements in emotional wellbeing and cognitive performance.”

The UC team decided to bring this intervention to Portugal after encouraging results from trials in the United Kingdom. They see it as "an important opportunity to expand non-pharmacological treatment options available within the National Health Service for pregnant and breastfeeding women experiencing depressive symptoms seeking non-pharmacological alternatives”. Ease of use at home and the non-pharmacological nature of the intervention were among the positive aspects highlighted by participants in the UK study, who reported improvements in mood, sleep, depressive symptoms, and overall wellbeing—some after just a few weeks.

In Portugal, the team conducted a focus-group study with women who have a history of depressive symptoms and perinatal mental health professionals to assess the acceptability of the treatment. The results were published in the scientific article Acceptability of remotely supervised home-based transcranial direct current stimulation combined with a cognitive-behavioural-based app for peripartum depression: perspectives from women with lived experience and mental health professionals. Symptom self-monitoring and ease of use were among the advantages highlighted.

Following this focus-group study, psychiatrists and clinical psychologists from Maternidade Bissaya Barreto received specialised training to implement the intervention. The treatment is currently being delivered to 40 pregnant or postnatal women, who will follow the programme over ten weeks.

“Through this observational study, we are analysing the feasibility of this combined treatment among women receiving care at Maternidade Bissaya Barreto,” Ana Ganho Ávila explains. Compared with other existing treatment options, the clinical psychologist highlights that “this intervention has a high safety profile, including for pregnant and breastfeeding women, with no known risks to either the mother or the baby.” For this reason, she adds, “it may be considered a safe alternative or complement to antidepressant medication, whose use is often associated with concern among mothers and families during pregnancy and the postnatal period, due to fears of foetal or infant exposure through the placenta or breast milk. In addition, the treatment can be carried out safely at home, avoiding the daily travel to clinical facilities required by other brain stimulation alternatives".

“Addressing maternal mental health is increasingly urgent, and Coimbra is a recognised reference in this field. This project represents a significant contribution, enabling the Local Health Unit of Coimbra (Coimbra ULS) to provide pregnant and postnatal patients with access to an innovative, non-invasive intervention,” highlights Francisco Maio Matos, Chair of the Board of Directors of Coimbra ULS. He adds that the project is “fully aligned with our commitment, as a university-affiliated health unit, to fostering research, innovation and knowledge, and to strengthening strategic links between Coimbra ULS and the wider academic and scientific community.”

The research is being conducted as part of the 4MUMs project, led by CINEICC. At UC, the research team includes Ana Ganho Ávila, Ana Telma Pereira (Faculty of Medicine), and researchers Mónica Sobral and Magdalena Iwanow (Faculty of Psychology and Educational Science). From Coimbra ULS, the team includes Joana Andrade, coordinator of the Psychiatry Day Hospital and deputy coordinator of the Neuromodulation Unit; Mariana Moura Ramos, Director of the Clinical Psychology Service; Teresa Almeida Santos, Director of the Department of Women’s and Newborn Health and professor at the Faculty of Medicine; psychiatrists Daniela Pereira and Vera Martins; and Cristina Vieira, clinical psychologist at Maternidade Bissaya Barreto.