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: 7.34). 01/2012; 200(1):52-9. DOI: 10.1192/bjp.bp.111.097634
Source: PubMed

ABSTRACT 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.

Download full-text


Available from: Veronica Galvez, Jul 28, 2015
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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
  • Source
    • "Beneficial effects of online stimulation applied over the left DLPFC have been reported for working memory, attentional performances, and information processing in depressed patients (Fregni et al., 2006; Oliveira et al., 2013; Wolkenstein and Plewnia, 2013). However, two randomized controlled trials and one open-label trial failed to replicate this finding with offline stimulation, suggesting that multiple tDCS sessions do not have cumulative cognitive enhancing effects (Ferrucci et al., 2009; Loo et al., 2012; Palm et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is a growing demand for new brain-enhancing technologies to improve mental performance, both for patients with cognitive disorders and for healthy individuals. Transcranial direct current stimulation (tDCS) is a non-invasive, painless, and easy to use neuromodulatory technique that can improve performance on a variety of cognitive tasks in humans despite its exact mode of action remains unclear. We have conducted a mini-review of the literature to first briefly summarize the growing amount of data from clinical trials assessing the efficacy of tDCS, focusing exclusively on learning and memory performances in healthy human subjects and in patients with depression, schizophrenia, and other neurological disorders. We then discuss these findings in the context of the strikingly few studies resulting from animal research. Finally, we highlight future directions and limitations in this field and emphasize the need to develop translational studies to better understand how tDCS improves memory, a necessary condition before it can be used as a therapeutic tool.
    Frontiers in Systems Neuroscience 09/2014; 8(159). DOI:10.3389/fnsys.2014.00159
  • Source
    • "Neuropsychological functioning was assessed at baseline and after 20 tDCS sessions. The battery of tests used was identical to those of the Loo et al. (2012) study and was chosen to examine performance of memory and frontal lobe functions. The tests administered included the Rey Auditory Verbal Learning Test (RAVLT; Rey, 1964), Digit Span (Wechsler, 1981, 1997), Letter Number Sequencing (LNS; Wechsler, 1997), Stroop Test (Regard, 1981), and Controlled Oral Word Association Test (COWAT; Benton and Hamsher, 1989). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Typically, transcranial direct current stimulation (tDCS) treatments for depression have used bifrontal montages with anodal (excitatory) stimulation targeting the left dorsolateral prefrontal cortex (DLPFC). There is limited research examining the effects of alternative electrode montages. Objective/hypothesis: This pilot study aimed to examine the feasibility, tolerability and safety of two alternative electrode montages and provide preliminary data on efficacy. The montages, Fronto-Occipital (F-O) and Fronto-Cerebellar (F-C), were designed respectively to target midline brain structures and the cerebellum. Methods: The anode was placed over the left supraorbital region and the cathode over the occipital and cerebellar region for the F-O and F-C montages respectively. Computational modelling was used to determine the electric fields produced in the brain regions of interest compared to a standard bifrontal montage. The two montages were evaluated in an open label study of depressed participants (N=14). Mood and neuropsychological functioning were assessed at baseline and after four weeks of tDCS. Results: Computational modelling revealed that the novel montages resulted in greater activation in the anterior cingulate cortices and cerebellum than the bifrontal montage, while activation of the DLPFCs was higher for the bifrontal montage. After four weeks of tDCS, overall mood improvement rates of 43.8% and 15.9% were observed under the F-O and F-C conditions, respectively. No significant neuropsychological changes were found. Limitations: The clinical pilot was open-label, without a control condition and computational modelling was based on one healthy participant. Conclusions: Results found both montages safe and feasible. The F-O montage showed promising antidepressant potential. Crown Copyright
    Journal of Affective Disorders 06/2014; 167C:251-258. DOI:10.1016/j.jad.2014.06.022 · 3.71 Impact Factor
Show more