Transcranial direct current stimulation and repetitive transcranial magnetic stimulation in consultation-liaison psychiatry

Abstract

Patients with clinical diseases often present psychiatric conditions whose pharmacological treatment is hampered due to hazardous interactions with the clinical treatment and/or disease. This is particularly relevant for major depressive disorder, the most common psychiatric disorder in the general hospital. In this context, nonpharmacological interventions could be useful therapies; and, among those, noninvasive brain stimulation (NIBS) might be an interesting option. The main methods of NIBS are repetitive transcranial magnetic stimulation (rTMS), which was recently approved as a nonresearch treatment for some psychiatric conditions, and transcranial direct current stimulation (tDCS), a technique that is currently limited to research scenarios but has shown promising results. Therefore, our aim was to review the main medical conditions associated with high depression rates, the main obstacles for depression treatment, and whether these therapies could be a useful intervention for such conditions. We found that depression is an important and prevalent comorbidity in a variety of diseases such as epilepsy, stroke, Parkinson's disease, myocardial infarction, cancer, and in other conditions such as pregnancy and in patients without enteral access. We found that treatment of depression is often suboptimal within the above contexts and that rTMS and tDCS therapies have been insufficiently appraised. We discuss whether rTMS and tDCS could have a significant impact in treating depression that develops within a clinical context, considering its unique characteristics such as the absence of pharmacological interactions, the use of a nonenteral route, and as an augmentation therapy for antidepressants.

Repetitive transcranial magnetic stimulation as an augmentative strategy for treatment-resistant depression, a meta-analysis of randomized, double-blind and sham-controlled study

“…With the development of neuroscience and psychiatry, we are now able to treat some TRDs with some physical method, such as electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation tDCS). Among these methods, ECT is the oldest and most effective while often criticized by the adverse effects of seizure induction and cognitive side effects [ 3 , 4 ], and patients who accepted ECT treatment often have to bear the stigma on this therapy [ 5 ].the limitations of ECT has resulted great interest in the two newly non-invasive neuromodulation methods: rTMS and tDCS, which are both of relatively low adverse effects and similar magnitude of antidepressant effects compared with antidepressant drugs [ 6 ].…”

The Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS): rationale and study design of a non-inferiority, triple-arm, placebo-controlled clinical trial

“…pregnant women, 86 HIV patients 87 and patients presenting clinical conditions in which the pharmacokinetic interactions are problematic. 88 Our study is also interesting from a cost-efficacy perspective, since tDCS is an affordable, portable and ease-to-use therapy. The cost of antidepressant therapy consisting of tDCS might, in fact, be comparable to that of antidepressant drugs, if it is taken into consideration that one tDCS device can be used to perform several applications per day and that one operator can deliver tDCS to two to three patients simultaneously.…”

Novel neurotherapeutics in psychiatry: use and rationale of transcranial direct current stimulation in major depressive disorder

“…Such improvement is in the same range of antidepressant drug treatment 54 and, in fact, two studies that directly compared tDCS vs. fluoxetine 29 and sertraline 43 found similar improvement rates in the pharmacological and non-pharmacological arms. This could suggest that tDCS might be a substitute for pharmacotherapy when its use is hindered, for instance, due to medical conditions 55 . The advantages of substituting medicines to tDCS are that the latter is virtually absent of side effects and pharmacological interactions.…”