Sharp Brains: Brain Fitness and Cognitive Health News

Neuroplasticity, Brain Fitness and Cognitive Health News

Icon

Transcranial Direct Current Stimulation shows early promise to ameliorate depression, especially if combined with other therapies and dosage optimized

___

Tran­scra­nial Direct Cur­rent Stim­u­la­tion Promis­ing for Major Depres­sive Dis­or­der (Psy­chi­a­try Advi­sor):

Tran­scra­nial direct cur­rent stim­u­la­tion (tDCS) is an inves­tiga­tive modal­i­ty for major depres­sive dis­or­der (MDD) that has shown some promis­ing results. Though it has a while before it is approved by the US Food and Drug Admin­is­tra­tion, clin­i­cians and patients have been clam­or­ing for an effec­tive treat­ment for MDD that is not asso­ci­at­ed with harm­ful adverse effects. As 6.7% of the world’s pop­u­la­tion has MDD, which is resis­tant to phar­ma­cother­a­py in approx­i­mate­ly one-third of cas­es, the push is on to iden­ti­fy treat­ment with last­ing effects to com­bat this dis­abling dis­or­der…

tDCS has pro­duced mixed results in patients with MDD. Brunoni and col­leagues per­formed a meta-analy­sis of indi­vid­ual patient data on 289 par­tic­i­pants with MDD (mean age, 47.2 years; 62.3% women) in 6 ran­dom­ized, sham-con­trolled stud­ies. tDCS sig­nif­i­cant­ly improved response com­pared with sham pro­ce­dures… Remis­sion rates were also favor­able. The tri­als did not uni­form­ly cat­e­go­rize adverse events, but the researchers not­ed that both the tDCS and sham groups had sim­i­lar drop-out rates.

tDCS effi­ca­cy is still small, and it should be opti­mized,” not­ed lead author André Rus­sowsky Brunoni, MD, PhD, asso­ciate pro­fes­sor at the Insti­tute of Psy­chi­a­try at the Uni­ver­si­ty of São Paulo Med­ical School in Brazil. “There are some approach­es for increas­ing its effi­ca­cy, such as com­bin­ing with oth­er ther­a­pies and/or increas­ing the dose, although this has not been sys­tem­at­i­cal­ly test­ed yet” … The appli­ca­tion of tDCS may ame­lio­rate depres­sion in patients with MDD. Despite some pos­i­tive sig­nals, tDCS remains an inves­tiga­tive ther­a­py in the Unit­ed States. More rig­or­ous stud­ies — includ­ing ran­dom­ized, sham-con­trolled, and dose-rang­ing tri­als — are need­ed to deter­mine opti­mal patient selec­tion.”

The meta-analysis

Tran­scra­nial direct cur­rent stim­u­la­tion for acute major depres­sive episodes: Meta-analy­sis of indi­vid­ual patient data (British Jour­nal of Psy­chi­a­try). From the abstract:

  • Back­ground: Tran­scra­nial direct cur­rent stim­u­la­tion (tDCS) is a non-phar­ma­co­log­i­cal inter­ven­tion for depres­sion. It has mixed results, pos­si­bly caused by study het­ero­gene­ity.
  • Aims: To assess tDCS effi­ca­cy and to explore indi­vid­ual response pre­dic­tors.
  • Method: Sys­tem­at­ic review and indi­vid­ual patient data meta-analy­sis.
  • Results: Data were gath­ered from six ran­domised sham-con­trolled tri­als, enrolling 289 patients. Active tDCS was sig­nif­i­cant­ly supe­ri­or to sham for response (34% v. 19% respec­tive­ly, odds ratio (OR) = 2.44, 95% CI 1.38–4.32, num­ber need­ed to treat (NNT) = 7), remis­sion (23.1% v. 12.7% respec­tive­ly, OR = 2.38, 95% CI 1.22–4.64, NNT = 9) and depres­sion improve­ment (B coef­fi­cient 0.35, 95% CI 0.12–0.57). Mixed-effects mod­els showed that, after adjust­ment for oth­er pre­dic­tors and con­founders, treat­ment-resis­tant depres­sion and high­er tDCS ‘dos­es’ were, respec­tive­ly, neg­a­tive­ly and pos­i­tive­ly asso­ci­at­ed with tDCS effi­ca­cy.
  • Con­clu­sions: The effect size of tDCS treat­ment was com­pa­ra­ble with those report­ed for repet­i­tive tran­scra­nial mag­net­ic stim­u­la­tion and anti­de­pres­sant drug treat­ment in pri­ma­ry care. The most impor­tant para­me­ters for opti­mi­sa­tion in future tri­als are depres­sion refrac­tori­ness and tDCS dose.

News in Context:

Leave a Reply...

Loading Facebook Comments ...

Leave a Reply

Categories: Cognitive Neuroscience, Health & Wellness, Professional Development, Technology

Tags: , , , , , , , , ,