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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.

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