Article

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

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 www.clinicaltrials.gov: 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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    • "Major depression has been associated with hypoactivity in the left dorsolateral prefrontal cortex (DLPFC) as demonstrated by PET, fMRI, and resting state EEG activity [20] [21] as well as observations of greater incidence of depression in patients affected by stroke with damage to this region [22]. Hence, TDCS, with the anode over the left DLPFC, may help increase regional activity [23] as has been supported by numerous pilot studies for depression [24] [25] [26] [27] [28]. There has been an independent effect in enhancing working memory in healthy subjects [29] [30] although the results have been variable [31] [32]. "
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    ABSTRACT: Introduction: Depression and memory dysfunction significantly impact the quality of life of patients with epilepsy. Current therapies for these cognitive and psychiatric comorbidities are limited. We explored the efficacy and safety of transcranial direct current stimulation (TDCS) for treating depression and memory dysfunction in patients with temporal lobe epilepsy (TLE). Methods: Thirty-seven (37) adults with well-controlled TLE were enrolled in a double-blinded, sham-controlled, randomized, parallel-group study of 5days of fixed-dose (2mA, 20min) TDCS. Subjects were randomized to receive either real or sham TDCS, both delivered over the left dorsolateral prefrontal cortex. Patients received neuropsychological testing and a 20-minute scalp EEG at baseline immediately after the TDCS course and at 2- and 4-week follow-up. Results: There was improvement in depression scores immediately after real TDCS, but not sham TDCS, as measured by changes in the Beck Depression Inventory (BDI change: -1.68 vs. 1.27, p<0.05) and NDDI-E (-0.83 vs. 0.9091, p=0.05). There was no difference between the groups at the 2- or 4-week follow-up. There was no effect on delayed or working memory performance. Transcranial direct current stimulation was well-tolerated and did not increase seizure frequency or interictal discharge frequency. Transcranial direct current stimulation induced an increase in delta frequency band power over the frontal region and delta, alpha, and theta band power in the occipital region after real stimulation compared to sham stimulation, although the difference did not reach statistical significance. Discussion: This study provides evidence for the use of TDCS as a safe and well-tolerated nonpharmacologic approach to improving depressive symptoms in patients with well-controlled TLE. However, there were no changes in memory function immediately following or persisting after a stimulation course. Further studies may determine optimal stimulation parameters for maximal mood benefit.
    Full-text · Article · Feb 2016 · Epilepsy & Behavior
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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.
    Full-text · Article · May 2015 · NeuroImage
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    • "This procedure ensures successful blinding of participants when using lower tDCS intensities (1 mA) (Gandiga et al., 2006; Ambrus et al., 2012) whereas it may be less effective at the intensity used in our study (2 mA) (O'Connell et al., 2012). However, the risk of unblinding should be minor considering that we did not use a cross-over design and all patients were na¨ıve to tDCS (see Loo et al., 2010, 2012 for evidence of effective blinding using similar stimulation parameters). Adverse events were monitored by asking patients after each session of stimulation and in the follow-up if they have experienced any adverse event and the relationship of these events to the treatment with tDCS. "
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    ABSTRACT: The aim of the study is to compare the effects of multiple sessions of cathodal (c-tDCS) or anodal tDCS (a-tDCS) in modulating the beneficial effects of prism adaptation (PA) treatment in neglect patients. 30 neglect patients were submitted to 10 daily sessions of PA treatment. Patients were pseudo-randomly divided into 3 groups. In the c-tDCS-group, each PA session was coupled with 20 minutes of cathodal stimulation of the left, intact PPC; in the a-tDCS-group, anodal stimulation was applied to PPC of the damaged hemisphere; in the Sham group, sham stimulation was applied. Neglect was evaluated before and after treatment with the Behavioral Inattention Test. Combined tDCS-PA treatment induced stronger neglect improvement in the a-tDCS group as compared to the Sham group. No improvement was found in the c-tDCSgroup, with respect to that normally induced by PA and found in the Sham group. c-tDCS abolished neglect amelioration after PA, possibly because stimulation affected the sensorimotor network controlling prism adaptation. Instead, a-tDCS PPC boosted neglect amelioration after PA probably thanks to increased excitability of residual tissue in the lesioned hemisphere, which in turn might reduce dysfunctional over-excitability of the intact hemisphere.
    Full-text · Article · Apr 2015
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Questions & Answers about this publication

  • Béatrice Marianne Ewalds-Kvist added an answer in tDCS:
    Can anyone direct me to a screening questionnaire when using tDCS?

    Would like (a) screening questionnaire for participants prior to participation and, (b) post-activity questionnaire to ascertain adverse effects resulting from stimulation protocol.

    Béatrice Marianne Ewalds-Kvist

    Dear David, 

    It depends what your are screening for e.g. depression: 

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      [Show abstract] [Hide abstract]
      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 www.clinicaltrials.gov: 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.
      Full-text · Article · Jan 2012 · The British journal of psychiatry: the journal of mental science

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