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

Abstract

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.

Can genetic polymorphisms predict response variability to anodal transcranial direct current stimulation of the primary motor cortex?

“…These changes are polarity‐dependent, with anodal‐tDCS (a‐tDCS) increasing CSE, and cathodal‐tDCS (c‐tDCS) reducing CSE (Nitsche & Paulus, 2000). This predictability has led to recent investigation into tDCS application in pathological population including Parkinson's disease (Broeder et al., 2019; Bueno et al., 2019), epilepsy (Lin et al., 2018; Tecchio et al., 2018) stroke rehabilitation (Biou et al., 2019; Solomons & Shanmugasundaram, 2019), cerebral palsy (Inguaggiato et al., 2019), chronic pain (Callai et al., 2019; Jafarzadeh et al., 2019), depression (Aparicio et al., 2019) and cognitive impairment (Emonson et al., 2019).…”

Can genetic polymorphisms predict response variability to anodal transcranial direct current stimulation of the primary motor cortex?

“…Nitsche & Paulus, 2000). This predictability has led to recent investigation into tDCS application in pathological population including Parkinson's disease (Broeder et al, 2019;Bueno et al, 2019), epilepsy (Lin et al, 2018;Tecchio et al, 2018) stroke rehabilitation (Biou et al, 2019;Solomons & Shanmugasundaram, 2019), cerebral palsy (Inguaggiato et al, 2019), chronic pain (Callai et al, 2019;Jafarzadeh et al, 2019), depression (Aparicio et al, 2019) and cognitive impairment (Emonson et al, 2019).…”

Precision non-implantable neuromodulation therapies: a perspective for the depressed brain

“…73,74 Only three studies have investigated continuation of tDCS sessions after the acute treatment phase. [75][76][77] All showed 6-month relapse rates varying from 25-50%. Interestingly, the study that reported the lowest relapse rate had tDCS performed twice a week, 76 whereas the one reporting higher relapse rates performed tDCS every other week.…”

“…[75][76][77] All showed 6-month relapse rates varying from 25-50%. Interestingly, the study that reported the lowest relapse rate had tDCS performed twice a week, 76 whereas the one reporting higher relapse rates performed tDCS every other week. 75 Taken together, this suggests an intensive tDCS treatment regimen is associated with lower relapse rates, although these studies were limited by small sample sizes and short follow-up periods.…”