Int J Neuropsychopharmacol. 2013 Sep 23:1-9. [Epub ahead of print]
Differential improvement in depressive symptoms for tDCS alone and combined with pharmacotherapy: an exploratory analysis from The Sertraline Vs. Electrical Current Therapy For Treating Depression Clinical Study.
Source
Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, SP, Brazil.
Abstract
Transcranial direct current stimulation (tDCS) is a promising therapy for major depression treatment, although little is known of its effects in ameliorating distinct symptoms of depression. Thus, it is important, not only to increase knowledge of its antidepressant mechanisms, but also to guide its potential use in clinical practice. Using data from a recent factorial, double-blinded, placebo-controlled trial applying tDCS-alone and combined with sertraline to treat 120 depressed outpatients over 6 wk (Brunoni et al., 2013), we investigated the pattern of improvement in symptoms of depression from the Montgomery-Asberg depression scale (MADRS). First, we performed one multivariate analysis of variance with the score improvement of the 10 MADRS items as dependent variables. Significant (p < 0.05) results were further explored with follow-up analyses of variance.TDCS (alone and combined with sertraline) improved concentration difficulties and pessimistic and suicidal thoughts. The combined treatment also improved apparent and reported sadness, lassitude and inability to feel. Indeed, tDCS/sertraline significantly ameliorated all but the 'vegetative'depression symptoms (inner tension, sleep and appetite items). We further discuss whether bifrontal tDCS over the dorsolateral prefrontal cortex could be associated with improvement in cognitive (concentration) and affective (pessimistic/suicidal thoughts) processing, while the combined treatment might have a more widespread antidepressant effect by simultaneously acting on different depression pathways. We also identified patterns of antidepressant improvement for tDCS that might aid in tailoring specific interventions for different subtypes of depressed patients, e.g. particularly those with suicidal ideation.
Clin Neurophysiol. 2013 Aug 29. pii: S1388-2457(13)00980-2. doi: 10.1016/j.clinph.2013.07.020. [Epub ahead of print]
Comparison of blinding effectiveness between sham tDCS and placebo sertraline in a 6-week major depressionrandomized clinical trial.
Source
Center for Clinical and Epidemiological Research, University Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil. Electronic address: brunoni@usp.br.
Abstract
OBJECTIVE:
To compare blinding integrity and associated factors for transcranial direct current stimulation (tDCS) vs. placebo-pill, the gold standard blinding method.
METHODS:
Parallel trial. Depressed participants were randomized to verum/placebo sertraline and active/sham tDCS (2mA, 30-min 10-daily sessions and two additional, fortnight sessions) over 6weeks. Blinding was assessed in completers (n=102) and in a random subgroup (n=35) of raters and participants, in which we also inquired to qualitatively describe their strongest guessing reason.
RESULTS:
Participants and raters presented similar performance for predicting treatment assignment at endpoint, correctly guessing tDCS and sertraline beyond chance. Nevertheless, clinical response was associated with correct prediction and tDCS non-responders failed to predict the allocation group. For tDCS, "trouble concentrating" was inversely associated with correct prediction. "Skin redness" was more reported for active-tDCS, but did not predict the allocation group. The qualitative reasons for raters' guessing were not associated with correct prediction, whereas for participants clinical response and adverse effects were directly and inversely associated with correct prediction, respectively.
CONCLUSION:
Blinding integrity of tDCS and sertraline were comparable and mainly associated with efficacy rather than blinding failure.
SIGNIFICANCE:
TDCS blinding can be improved by adopting parallel designs and avoiding subjects' awareness of skin redness.
Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
KEYWORDS:
Clinical trial, Double-blind methods, Major depressive disorder, Placebo, Transcranial direct current stimulation
- PMID:
- 23994192
- [PubMed - as supplied by publisher]
- J ECT. 2013 Sep;29(3):196-200. doi: 10.1097/YCT.0b013e3182801b09.
Augmenting transcranial direct current stimulation with (D)-cycloserine for depression: a pilot study.
Source
School of Psychiatry, University of New South Wales, Sydney, Australia. chan.herng.nieng@sgh.com.sgAbstract
OBJECTIVES:
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that causes changes in cortical excitability. Recent double-blind placebo-controlled clinical trials suggest that tDCS may be efficacious in the treatment of depression. Pharmacological agents that prolong the effects of tDCS could lead to greater cumulative changes in cortical excitability, producing greater and more prolonged efficacy. One agent shown to prolong the excitability-enhancing effects of tDCS in healthy subjects is D-Cycloserine, a partial agonist at the glycine-binding site of N-methyl-D-aspartate receptors. We investigated whether combining prefrontal tDCS with D-Cycloserine could enhance and/or prolong the antidepressant effect of tDCS.METHODS:
Five depressed subjects who had relapsed or failed to achieve remission after receiving a previous course of prefrontal tDCS were recruited. In this open-label pilot study, subjects ingested 100-mg D-Cycloserine 2 hours before tDCS sessions. Subjects received 20 minutes of tDCSat 2 mA on consecutive weekdays for a total of 20 sessions. The anode was placed at pF3 and the cathode at F8 (10/20 system). Clinical response was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS).RESULTS:
The change in Montgomery-Åsberg Depression Rating Scale scores was not greater with the combination of D-Cycloserine and tDCSthan had previously been produced by tDCS alone. No significant additional adverse effects were reported.CONCLUSIONS:
This pilot open-label study found that pretreatment with 100-mg D-Cycloserine 2 hours before tDCS was well tolerated but did not enhance the antidepressant efficacy of anodal prefrontal tDCS.J Affect Disord. 2013 Sep 5;150(2):659-63. doi: 10.1016/j.jad.2013.03.015. Epub 2013 May 7.Serum levels of brain-derived neurotrophic factor are unchanged after transcranial direct current stimulation in treatment-resistant depression.
Palm U, Fintescu Z, Obermeier M, Schiller C, Reisinger E, Keeser D, Pogarell O, Bondy B, Zill P, Padberg F.Source
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany. ulrich.palm@med.uni-muenchen.deAbstract
BACKGROUND:
Brain-derived neurotrophic factor (BDNF) plays an important role in differentiation and repair of neurons in the adult brain. BDNF serum levels have been found to be lower in depressed patients than in healthy subjects. In a couple of studies, effective antidepressant treatment including electroconvulsive therapy led to an increase in BDNF serum levels. As transcranial direct current stimulation (tDCS) is currently discussed as novel therapeutic intervention in major depression, we investigated BDNF serum levels during tDCS in therapy-resistant depression.METHODS:
Twenty-two patients with a major depressive episode participated in a double-blind placebo-controlled trial and received randomized cross over treatment with 2 weeks active and 2 weeks sham tDCS (1 or 2 mA for 20 min, anode over the left dorsolateral prefrontal cortex, cathode right supraorbital cortex).RESULTS:
Clinical assessment only showed a modest and non-significant improvement in HAMD, BDI and CGI in both groups. BDNF serum levels were measured at baseline, after 2 and after 4 weeks. There was neither a significant change of BDNF levels following active tDCS, nor were severity of depressive symptoms and BDNF levels correlated.LIMITATIONS:
The small sample size, its heterogeneity, the short observation period and a cross-over design without an interval between both conditions.CONCLUSIONS:
tDCS did not change BDNF serum levels unlike other established antidepressant interventions in this treatment resistant sample. However, larger studies are needed.Copyright © 2013 Elsevier B.V. All rights reserved.
KEYWORDS:
BDNF serum levels, Major depressive disorder, Transcranial direct current stimulation, tDCSNeuroreport. 2013 Oct 30. [Epub ahead of print]Long-term effects of transcranial direct current stimulation combined with computer-assisted cognitive training in healthy older adults.
Source
aDepartment of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonbuk bDepartment of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Abstract
The aim of the present study was to analyze the long-term effects of transcranial direct current stimulation (tDCS) of the bilateral prefrontal cortex combined with computer-assisted cognitive training on working memory and cognitive function in healthy older adults aged at least 65 years. Forty healthy older adults were enrolled and randomly assigned to two groups: anodal and sham tDCS. All participants completed 10 sessions of computer-assisted cognitive training, combined with tDCS of the bilateral prefrontal cortex. The accuracy of the verbal working memory task and performance of the digit span forward test were significantly improved after computer-assisted cognitive training combined with bifrontal anodal tDCS as compared with that after computer-assisted cognitive training combined with sham tDCS. Moreover, the effect lasts for 4 weeks in the verbal working memory task. We suggest that the tDCS-induced changes in the bilateral prefrontal excitability during computer-assisted cognitive training may have beneficial effects on age-related cognitive decrement in healthy older adults.
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