Transcranial direct current stimulation for depression: 3-Week, randomised, sham-controlled trial

School of Psychiatry, University of New South Wales, Sydney, Australia.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 01/2012; 200(1):52-9. DOI: 10.1192/bjp.bp.111.097634
Source: PubMed


Preliminary evidence suggests transcranial direct current stimulation (tDCS) has antidepressant efficacy.
To further investigate the efficacy of tDCS in a double-blind, sham-controlled trial (registered at NCT00763230).
Sixty-four participants with current depression received active or sham anodal tDCS to the left prefrontal cortex (2 mA, 15 sessions over 3 weeks), followed by a 3-week open-label active treatment phase. Mood and neuropsychological effects were assessed.
There was significantly greater improvement in mood after active than after sham treatment (P<0.05), although no difference in responder rates (13% in both groups). Attention and working memory improved after a single session of active but not sham tDCS (P<0.05). There was no decline in neuropsychological functioning after 3-6 weeks of active stimulation. One participant with bipolar disorder became hypomanic after active tDCS.
Findings confirm earlier reports of the antidepressant efficacy and safety of tDCS. Vigilance for mood switching is advised when administering tDCS to individuals with bipolar disorder.

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Available from: Veronica Galvez, Oct 03, 2015
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    • "During the sham stimulation condition once the current reached approximately half of the active stimulation value (i.e., 1 mA) it was ramped back down over 30 s and then switched off. A similar procedure has been shown to elicit minimal discomfort and to be indistinguishable from active stimulation by study participants (Gandiga et al., 2006; Loo et al., 2012; Nitsche et al., 2005). All adjustments to the current were conducted out of view behind the participants and further precautions were taken to cover the machine in use to obscure any visual indications of the level of current used. "
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    ABSTRACT: Declarative verbal learning and memory is known to be lateralised to the dominant hemisphere and to be subserved by a network of structures, including those located in frontal and temporal regions. These structures support critical components of verbal memory, including working memory, encoding, and retrieval. Their relative functional importance in facilitating declarative verbal learning and memory, however, remains unclear. To investigate the different functional roles of these structures in subserving declarative verbal learning and memory performance by applying a more focal form of transcranial direct current stimulation, "High Definition tDCS" (HD-tDCS). Additionally, we sought to examine HD-tDCS effects and electrical field intensity distributions using computer modelling. HD-tDCS was administered to the left dorsolateral prefrontal cortex (LDLPFC), planum temporale (PT), and left medial temporal lobe (LMTL) to stimulate the hippocampus, during learning on a declarative verbal memory task. Sixteen healthy participants completed a single blind, intra-individual cross-over, sham-controlled study which used a Latin Square experimental design. Cognitive effects on working memory and sustained attention were additionally examined. HD-tDCS to the LDLPFC significantly improved the rate of verbal learning (p=0.03, η(2)= 0.29) and speed of responding during working memory performance (p=0.02, η(2)= 0.35), but not accuracy (p=0.12, η(2)= 0.16). No effect of tDCS on verbal learning, retention, or retrieval was found for stimulation targeted to the LMTL or the PT. Secondary analyses revealed that LMTL stimulation resulted in increased recency (p=0.02, η(2)= 0.31) and reduced mid-list learning effects (p=0.01, η(2)= 0.39), suggesting an inhibitory effect on learning. HD-tDCS to the LDLPFC facilitates the rate of verbal learning and improved efficiency of working memory may underlie performance effects. This focal method of administrating tDCS has potential for probing and enhancing cognitive functioning. Copyright © 2015. Published by Elsevier Inc.
    NeuroImage 05/2015; 117. DOI:10.1016/j.neuroimage.2015.05.019 · 6.36 Impact Factor
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    • "However, multiple sessions require subjects to repeatedly travel to the clinic for each treatment, placing significant and often insurmountable burden to patients and their caregivers, at the same time associated with significant provider time and cost, especially as the sample size increases (Brunoni et al., 2012a; Holland and Crinion, 2012; Ferrucci et al., 2014; Meesen et al., 2014; Shiozawa et al., 2014; Vaseghi et al., 2014). For example, in a sample of 64 subjects treated for depression, Loo et al. administered 30 sessions across 6 weeks (Loo et al., 2012), followed by up to 20 maintenance treatment sessions spaced over 6 months (Martin et al., 2013a). Similarly, during the 6 month follow up of a depression trial, Valiengo and colleagues showed a dropout rate of 17 of 42 subjects---with almost all dropouts citing the burden of regular visits to the clinic (Valiengo et al., 2013). "
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    ABSTRACT: The effect of transcranial direct current stimulation (tDCS) is cumulative. Treatment protocols typically require multiple consecutive sessions spanning weeks or months. However, traveling to clinic for a tDCS session can present an obstacle to subjects and their caregivers. With modified devices and headgear, tDCS treatment can be administered remotely under clinical supervision, potentially enhancing recruitment, throughput, and convenience. Here we propose standards and protocols for clinical trials utilizing remotely-supervised tDCS with the goal of providing safe, reproducible and well-tolerated stimulation therapy outside of the clinic. The recommendations include: (1) training of staff in tDCS treatment and supervision; (2) assessment of the user's capability to participate in tDCS remotely; (3) ongoing training procedures and materials including assessments of the user and/or caregiver; (4) simple and fail-safe electrode preparation techniques and tDCS headgear; (5) strict dose control for each session; (6) ongoing monitoring to quantify compliance (device preparation, electrode saturation/placement, stimulation protocol), with corresponding corrective steps as required; (7) monitoring for treatment-emergent adverse effects; (8) guidelines for discontinuation of a session and/or study participation including emergency failsafe procedures tailored to the treatment population's level of need. These guidelines are intended to provide a minimal level of methodological rigor for clinical trials seeking to apply tDCS outside a specialized treatment center. We outline indication-specific applications (Attention Deficit Hyperactivity Disorder, Depression, Multiple Sclerosis, Palliative Care) following these recommendations that support a standardized framework for evaluating the tolerability and reproducibility of remote-supervised tDCS that, once established, will allow for translation of tDCS clinical trials to a greater size and range of patient populations.
    Frontiers in Systems Neuroscience 03/2015; 9:26. DOI:10.3389/fnsys.2015.00026
    • "In accordance to its general clinical effects, a couple of studies have shown that prefrontal tDCS in MDD is able to improve cognitive functions, and emotion-related information processing. Loo et al. demonstrated positive cognitive effects of prefrontal tDCS conducted over 3 weeks in MDD (Loo et al., 2012). Beyond positive effects on clinical symptoms, attention and working memory evaluated via the Symbol Digit Modalities Test improved after a single session of active, but not sham tDCS. "
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    ABSTRACT: Non-invasive brain stimulation is a versatile tool to modulate psychological processes via alterations of brain activity, and excitability. It is applied to explore the physiological basis of cognition and behavior, as well as to reduce clinical symptoms in neurological and psychiatric diseases. Neuromodulatory brain stimulation via transcranial direct currents (tDCS) has gained increased attention recently. In this review we will describe physiological mechanisms of action of tDCS, and summarize its application to modulate psychological processes in healthy humans and neuropsychiatric diseases. Furthermore, beyond giving an overview of the state of the art of tDCS, including limitations, we will outline future directions of research in this relatively young scientific field. Copyright © 2015. Published by Elsevier Ltd.
    Neuropsychologia 02/2015; 69. DOI:10.1016/j.neuropsychologia.2015.02.002 · 3.30 Impact Factor
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