Efficacy and Safety of Transcranial Direct Current Stimulation as an Add-on Treatment for Bipolar Depression

Sampaio-Júnior, Bernardo; Tortella, Gabriel; Borrione, Lucas; Moffa, Adriano H.; Machado‐Vieira, Rodrigo; Cretaz, Eric; Silva, Adriano Fernandes da; Fráguas, Renério; Aparicio, Luana V Marotti; Klein, Izio; Lafer, Beny; Goerigk, Stephan; Benseñor, Isabela M.; Lotufo, Paulo A; Gattaz, Wagner F.; Brunoni, André R.

doi:10.1001/jamapsychiatry.2017.4040

Cited by 100 publications

(59 citation statements)

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“…The interventions were 12 tDCS sessions or sham (10 sessions once a day for 2 weeks and then one session every other week until week 6). The main outcome was that active tDCS was superior to sham (Sampaio‐Junior et al., ).…”

Section: Methodsmentioning

confidence: 99%

“…Participants were recruited and enrolled as described in previously published studies ELECT‐TDCS (Brunoni et al., ) and BETTER (Sampaio‐Junior et al., ).…”

Section: Methodsmentioning

confidence: 99%

“…In BETTER, patients were aged between 18 and 65 years old and had been diagnosed with type I or II bipolar disorder in an acute depressive episode. Participants were in a stable drug regimen for at least 2 and 4 weeks for mood stabilizers and antidepressant drugs, respectively (Sampaio‐Junior et al., ).…”

Section: Methodsmentioning

confidence: 99%

“…Considering the importance of the maintenance phase of the depressive episode, it is critical to better explore tDCS regimens that could induce greater efficacy. We report the relapse rates of a 6‐month follow‐up data from our two randomized clinical trials that examined tDCS efficacy for unipolar (Brunoni et al., ) and bipolar (Sampaio‐Junior et al., ) depression. All patients were tDCS responders at follow‐up onset and underwent tDCS twice a week for 6 months.…”

Section: Introductionmentioning

confidence: 99%

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Transcranial direct current stimulation (tDCS) for preventing major depressive disorder relapse: Results of a 6-month follow-up

et al. 2019

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Background The efficacy of transcranial direct current stimulation (tDCS) as a continuation therapy for the maintenance phase of the depressive episode is low and insufficiently investigated in literature. We investigated whether it could be enhanced by using a more intensive treatment regimen compared to previous reports. Methods Twenty‐four patients (16 with unipolar depression and eight with bipolar depression) who presented acute tDCS response (≥50% depression improvement in the Hamilton Depression Rating Scale [HDRS]) after receiving 15 tDCS sessions were followed for up to 6 months or until relapse, defined as clinical worsening and/or HDRS > 15. Sessions were performed twice a week (maximum of 48 sessions) over 24 weeks. The anode and the cathode were positioned over the left and right dorsolateral prefrontal cortex (2 mA current, 30 min sessions were delivered). We performed Kaplan–Meier survival analysis and Cox proportional hazards ratios to evaluate predictors of relapse. Results Out of 24 patients, 18 completed the follow‐up period. tDCS treatment was well tolerated. The mean survival duration was 17.5 weeks (122 days). The survival rate at the end of follow‐up was 73.5% (95% confidence interval, 50–87). A trend (P = 0.09) was observed for lower relapse rates in nontreatment‐ vs. antidepressant treatment‐resistant patients (7.7% vs. 45.5%, respectively). No differences in efficacy between unipolar and bipolar depression were observed. Conclusion An intensive tDCS treatment regimen consisting of sessions twice a week achieved relatively low relapse rates after a 6‐month follow up of tDCS responders, particularly for nontreatment‐resistant patients.

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Section: Methodsmentioning

confidence: 99%

“…Participants were recruited and enrolled as described in previously published studies ELECT‐TDCS (Brunoni et al., ) and BETTER (Sampaio‐Junior et al., ).…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transcranial direct current stimulation (tDCS) for preventing major depressive disorder relapse: Results of a 6-month follow-up

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“…1 Recently, a meta-analysis suggested that tDCS could also be a potential and well-tolerated therapeutic option for patients with bipolar disorder (BD) experiencing a major depressive episode (MDE) for which standard treatments are often inefficient and/or associated with a risk of manic switch. 2,3 We report here the case of a patient with a history of bipolar depression, with a severe intolerance to medications in the context of a comorbid spinocerebellar ataxia (SCA), who achieved full symptomatic recovery after being treated with tDCS over a 2-week protocol (Figure 1). Mrs R is a 70-year-old patient who fulfilled the DSM-5 diagnostic criteria for type I BD and consulted our Psychiatry Department for a treatment-resistant MDE (Montgomery-Asberg Depression Rating Scale (MADRS) = 38/60).…”

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Efficacy of tDCS for bipolar depression in a patient with spinocerebellar ataxia: A case report

Granon

Bénard

Devos³

et al. 2020

Bipolar Disorders

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Transcranial direct current stimulation (tDCS) is a safe non-pharmacological and non-invasive technique consisting of administering direct, weak electric currents into the brain using electrodes placed on the scalp to induce neuroplasticity and modulate cortical function beyond the period of stimulation. tDCS recently appeared as an experimental treatment for various neuropsychiatric conditions including major depressive disorder. 1 Recently, a meta-analysis suggested that tDCS could also be a potential and well-tolerated therapeutic option for patients with bipolar disorder (BD) experiencing a major depressive episode (MDE) for which standard treatments are often inefficient and/or associated with a risk of manic switch. 2,3 We report here the case of a patient with a history of bipolar depression, with a severe intolerance to medications in the context of a comorbid spinocerebellar ataxia (SCA), who achieved full symptomatic recovery after being treated with tDCS over a 2-week protocol (Figure 1). Mrs R is a 70-year-old patient who fulfilled the DSM-5 diagnostic criteria for type I BD and consulted our Psychiatry Department for a treatment-resistant MDE (Montgomery-Asberg Depression Rating Scale (MADRS) = 38/60). Informed consent was obtained from the patient for publication of this case report. The diagnosis of type I BD was based on a manic episode in 1990 (Young Mania Rating Scale (YMRS) >25) as well as multiple MDEs. Mrs R was also suffering from a SCA, diagnosed in 2009 after the apparition and the progressive worsening of cerebellar symptoms including cerebellar ataxia at lower and upper limbs, dysarthria, dysgraphia, hypotonia, and nystagmus. No cause for sporadic cerebellar ataxia and no familial history of SCA were found. The most frequent gene mutations (SCA1, 2, 3, 6, Friedreich ataxia) have been ruled out and standard blood tests were normal. The molecular diagnosis is currently in progress.Mrs R. has been treated over the past 15 years with a variety of pharmacological treatment, mainly selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) in monotherapy or in association with different class of mood stabilizers such as aripiprazole, valproic acid, lithium, or lamotrigine. The patient described a worsening of SCA symptoms following either the introduction or increase in the dose of all these mood stabilizers. When we met her, she had stopped all pharmacological treatments. Considering the patient preference, we first tried to carefully reintroduce lamotrigine in association with venlafaxine but each increase in lamotrigine dose was associated with a worsening of ataxia. Because of BD, we did not want to simply increase the venlafaxine dose without any efficient concurrent mood stabilizer due to the risk of antidepressant-induced mania. We tried multiple pharmacological adjustments based on these two medications over an 18-month period, but the patient kept suffering from MDE, sometimes associated with suicidal thoughts, with a MADRS score over 20/60. ...

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Efficacy and Safety of Transcranial Direct Current Stimulation for Treating Negative Symptoms in Schizophrenia

et al. 2020

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IMPORTANCE Negative symptoms represent a substantial burden in schizophrenia. Although preliminary studies have suggested that transcranial direct current stimulation (tDCS) is effective for some clusters of symptoms, the clinical benefits for negative symptoms are unclear.OBJECTIVE To determine the efficacy and safety of tDCS vs sham as an add-on treatment for patients with schizophrenia and predominant negative symptoms. DESIGN, SETTING, AND PARTICIPANTS The double-blind Schizophrenia Treatment With Electric Transcranial Stimulation (STARTS) randomized clinical trial was conducted from September 2014 to March 2018 in 2 outpatient clinics in the state of São Paulo, Brazil. Patients with schizophrenia with stable negative and positive symptoms and a minimum score of 20 points in the negative symptoms subscale of the Positive and Negative Syndrome Scale (PANSS) were included. INTERVENTIONS Ten sessions of tDCS performed twice a day for 5 days or a sham procedure. The anode and the cathode were positioned over the left prefrontal cortex and the left temporoparietal junction, respectively. MAIN OUTCOMES AND MEASURESChange in the PANSS negative symptoms subscale score at week 6 was the primary outcome. Patients were followed-up for an additional 6 weeks. RESULTSOf the 100 included patients, 20 (20.0%) were female, and the mean (SD) age was 35.3 (9.3) years. A total of 95 patients (95.0%) finished the trial. In the intention-to-treat analysis, patients receiving active tDCS showed a significantly greater improvement in PANSS score compared with those receiving the sham procedure (difference, 2.65; 95% CI, 1.51-3.79; number needed to treat, 3.18; 95% CI, 2.12-6.99; P < .001). Response rates for negative symptoms (20% improvement or greater) were also higher in the active group (20 of 50 [40%]) vs the sham group (2 of 50 [4%]) (P < .001). These effects persisted at follow-up. Transcranial direct current stimulation was well tolerated, and adverse effects did not differ between groups, except for burning sensation over the scalp in the active group (43.8%) vs the sham group (14.3%) (P = .003).CONCLUSIONS AND RELEVANCE Transcranial direct current stimulation was effective and safe in ameliorating negative symptoms in patients with schizophrenia.

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Efficacy and Safety of Transcranial Direct Current Stimulation as an Add-on Treatment for Bipolar Depression

Abstract: clinicaltrials.gov Identifier: NCT02152878.

Cited by 100 publications

References 47 publications

Transcranial direct current stimulation (tDCS) for preventing major depressive disorder relapse: Results of a 6-month follow-up

Transcranial direct current stimulation (tDCS) for preventing major depressive disorder relapse: Results of a 6-month follow-up

Efficacy of tDCS for bipolar depression in a patient with spinocerebellar ataxia: A case report

Efficacy and Safety of Transcranial Direct Current Stimulation for Treating Negative Symptoms in Schizophrenia

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