Application of Transcranial Direct Current Stimulation in Psychiatry

Abstract

Transcranial direct current stimulation (tDCS) is a neuromodulation technique, which noninvasively alters cortical excitability via weak polarizing currents between two electrodes placed on the scalp. Since it is comparably easy to handle, cheap to use and relatively well tolerated, tDCS has gained increasing interest in recent years. Based on well-known behavioral effects, a number of clinical studies have been performed in populations including patients with major depressive disorder followed by schizophrenia and substance use disorders, in sum with heterogeneous results with respect to efficacy. Nevertheless, the potential of tDCS must not be underestimated since it could be further improved by systematically investigating the various stimulation parameters to eventually increase clinical efficacy. The present article briefly explains the underlying physiology of tDCS, summarizes typical stimulation protocols and then reviews clinical efficacy for various psychiatric disorders as well as prevalent adverse effects. Future developments include combined and more complex interactions of tDCS with pharmacological or psychotherapeutic interventions. In particular, using computational models to individualize stimulation protocols, considering state dependency and applying closed-loop technologies will pave the way for tDCS-based personalized interventions as well as the development of home treatment settings promoting the role of tDCS as an effective treatment option for patients with mental health problems.

Role of Transcranial Direct Current Stimulation in the Management of Post-Stroke Depression

“…In the current study there were no side-effects in the treated group. Similar findings were reported by Herrera-Melendez et al (2019), that tDCS is well tolerated, comparably easy to handle and cheap to use [25].…”

“…Pharmacological treatments have limited efficacy and important adverse effects. Noninvasive neurostimulatory and neuromodulatory techniques; TMS and tDCS are rapidly emerging as a therapeutic strategy in various psychiatric disorders [25]. The current study results revealed that tDCS intervention caused a significant decrease in depression assessed by HDS in the actively treated group (A).…”

“…The anode stimulation is known to increase the excitability of cerebral cortex, while the cathode stimulation is known to suppress the excitability of the cerebral cortex [28]. It can be assumed that the improvement of depression was caused by tDCS might be due to the modulation of serotonergic and dopaminergic systems, which have traditionally been associated with the pathogenesis of affective disorders [25].…”

Supervised transcranial direct current stimulation (tDCS) at home: A guide for clinical research and practice

“…Following the implementation of the initial basic recommendations and guidelines for at-home tDCS in clinical trials [50], the purpose of this work is to provide a comprehensive guide to operationalize safe and responsible use of tDCS in home settings. While our primary goal of at-home use is to facilitate clinical research, we acknowledge that clinical use varies across countries in terms of regulatory frameworks [29] and that there are clinicians who employ tDCS for off-label clinical use in the U.S. [22,24,25,51]. Therefore, we address tDCS home use in both investigative and clinical contexts.…”

Editorial

“…Pharmacological experiments suggest that glutamatergic mechanisms like N-methyl-D-aspartate receptors are involved in plasticity-related processes induced by tDCS. Other studies point to a tDCS-mediated effect on serotonergic and dopaminergic systems [4]. Clinical studies conducted so far are very promising in having an additional tool to treat psychiatric disorders in the near future.…”