Transcranial Direct Current Stimulation (tDCS) for Depression during Pregnancy: Results from an Open-Label Pilot Study

Abstract

Introduction: Depression is the most common morbidity during pregnancy. Available first-line therapy options are limited and depressive disorders in pregnant women are often untreated, leading to negative effects on maternal and fetal health. Objectives: The aim of this open-label pilot study is to extend evidence on the use of transcranial direct current stimulation (tDCS) as a treatment of antenatal depression and to point out options for the use of tDCS in this population. Methods: Six drug-free female patients with major depressive disorder during pregnancy (later than 10th gestational week) were included in this pilot study. Patients were treated with twice-daily tDCS (2 mA, 30 min, anode: F3, cathode: F4) over ten days during inpatient stay (Phase 1) and with once-daily tDCS over 10 days during an optional outpatient stay (Phase 2). Clinical (HAMD-21, BDI) and neuropsychological ratings (Trail Making Test A/B) were performed at baseline, after two and four weeks as well as an obstetric examination. Results: Six right-handed females (23–43 years, 12–33. gestational week) completed Phase 1; four patients additionally joined in Phase 2. tDCS was well tolerated and no adverse effects occurred. Clinical ratings showed an improvement of mean baseline HAMD-21 from 22.50 ± 7.56 to 13.67 ± 3.93 after week 2, and to 8.75 ± 4.99 after week 4. The mean baseline BDI was 26.00 ± 13.90 and declined to 11.17 ± 5.46 after week 2, and to 9.25 ± 3.30 after week 4. Conclusions: Statistically significant changes in HAMD-21 and BDI were observed after Phase 1. One patient achieved remission in terms of HAMD in Phase 1. Although this small-scale study lacks sham control, it shows clinical improvement and absence of adverse events in this critical population.

Ten Sessions of 30 Min tDCS over 5 Days to Achieve Remission in Depression: A Randomized Pilot Study

“…The present results may also support the clinical interest of delivering two sessions of tDCS per day to achieve remission. This is in line with previous studies with comparable sample sizes, also reporting the beneficial effects of tDCS with two 30 min sessions per day, in a case-series of six patients with depressive disorders [9], six drug free patients with depression during pregnancy [20], and in a sample of 93 elderly participants [10]. The results are also consistent with studies reporting a beneficial effect of two 20 min sessions per day in 31 patients with depression (e.g., [21]), as well as in 30 patients with schizophrenia [22].…”

Efficacy and Safety of Transcranial Electric Stimulation during the Perinatal Period: A Systematic Literature Review and Three Case Reports

“…tDCS was well tolerated with an improvement in trail making test scores (executive functions). The second open-label trial included six pregnant women, ranging from the first to the second trimester of pregnancy [ 54 ]. tDCS treatment was adjunctive to psychotherapy, resulting in an improvement in depression symptoms at the two-week follow-up (phase 1).…”

Limited output transcranial electrical stimulation 2023 (LOTES-2023): Updates on engineering principles, regulatory statutes, and industry standards for wellness, over-the-counter, or prescription devices with low risk

“…On the March 12, 2022, we repeated the search in PubMed, adding “tPCS” to the search terms. One new published report was found [ 89 ] which is an extension of Palm et al (2017) [ 84 ]. Table 2 depicts the characteristics of the studies included and in Table 3 we present a summary of the reports regarding safety across the included studies.…”

“…In what concerns tDCS, we found three studies reporting its use to manage depressive symptoms during pregnancy (we consider Palm et al, 2017 [ 84 ] and Kurzeck et al, 2021 [ 89 ] as one single study), that included a total of 16 women between the first and second trimester of pregnancy. Overall, 330 tDCS sessions were completed.…”