Transcranial Direct Current Stimulation for Treatment-Resistant Major Depression: A Double-Blind Randomized Sham-Controlled Trial

Abstract

In the current study, we tried to evaluate the effect of transcranial direct current stimulation (tDCS) on treatment-resistant major depression. We carried out a double-blind randomized sham-controlled trial was conducted in University Hospitals. Individuals with less than 50% decrease in the intensity of depression after 8 weeks of treatment with selective serotonin reuptake inhibitors were recruited. Thirty patients (16 women) with a mean (SD) age of 47.2 (12.0) years were randomly allocated to 2 groups. For the active group we administered 2-mA stimulation 20 minutes for each session, with 30 seconds ramp-up from 0 and 30 seconds ramp-down. For the sham group we administered 30 seconds ramp-up to 2 mA, 10 seconds stimulation, 30 seconds ramp-down, and 20 minutes no current. The anode was fixed on the center of F3, and the cathode on F4, over the dorsolateral prefrontal cortex. We assessed the Hamilton Depression Rating Scale at the baseline (mean difference = 1.0, P = .630), at the last session of tDCS, and at 1-month postintervention. There were statistically significant differences in the mean Hamilton scores after the intervention, and 1 month later in favor of active group; P < .001, and P = .003, respectively. Mixed analysis of variance showed a significant difference in the mean scores for active group P = .010 and pattern of change during the study P < .001 in favor of active intervention. We concluded that tDCS is an efficient therapy for patients with resistant major depression, and the benefits would remain at least for 1 month.

Follow-up effects of transcranial direct current stimulation (tDCS) for the major depressive episode: A systematic review and meta-analysis

“…1). Thus, 11 studies (13 datasets) (Alonzo et al, 2019;Aparicio et al, 2019;Bennabi et al, 2015;Boggio et al, 2008;Dell'Osso et al, 2014;Loo et al, 2018Loo et al, , 2012Loo et al, , 2010Martin et al, 2013;Sharafi et al, 2019;Valiengo et al, 2013) met the inclusion criteria, with 311 participants. One study conducted an interventional and an observational follow-up and was then included in both groups (Alonzo et al, 2019).…”

Effectiveness of transcranial direct current stimulation alone or associated with antidepressants, psychotherapy or cognitive therapies for the management of major depression – a review on clinical trials

“…Even in the study by Pavlova et al (2018) (Pavlova et al, 2018), the stimulation of 0.5mA combined with sertraline showed significant clinical improvement, being greater for the group with the longest stimulation time (30 minutes). Among the studies that used the highest current intensity (2 mA), there were significant (Andre R Brunoni et al, 2013;Segrave et al, 2014;Sharafi et al, 2019) and non-significant results (Bennabi et al, 2015;A R Brunoni et al, 2014;Vanderhasselt et al, 2015). Nord et al (2019) used an intermediate current intensity (1 mA) and also found no significant results when combining TDCS and CBT.…”

“…Finally, the analysis of TDCS effectiveness on patients undergoing refractory treatment with selective sertraline reuptake inhibitors (SSRIs) treatment was brought by two studies (Dell'Osso et al, 2014;Sharafi et al, 2019) with opposite results. Again, the final outcomes could have been impacted by methodological issues, such as different electrode arrangement, current intensity, as well as time and interval between sessions.…”

“…3) Replicating the experimental design of Sharafi et al (2019) (Sharafi et al, 2019), who employed TDCS in patients resistant to pharmacotherapy, would results be similar if electrodes were arranged at F3 (anode) and F4 (cathode)? 4) In MD patients resistant to pharmacotherapy and submitted to anodic TDCS at F3 region, is there a difference between the cathode arrangement in F4 and Fp2, in different groups of the same sample?…”

Peripheral biomarkers in Repeated Ketamine Infusions Trial

“…Other neurostimulation techniques that have shown some efficacy for TRD include transcranial direct current stimulation (tDCS) (Sharafi, Taghva, Arbabi, Dadarkhah, & Ghaderi, 2019); vagus nerve stimulation (VNS) (Berry et al, 2013); deep brain stimulation (DBS) (Berlim, McGirr, Van Den Eynde, Fleck, & Giacobbe, 2014); and magnetic seizure therapy (MST) (Kayser et al, 2015). However, these treatments are not commonly used because more evidence into their efficacy and tolerability is necessary before they become recommended and widely available treatments (Milev et al, 2016).…”