Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-10T16:35:00.117Z Has data issue: false hasContentIssue false
  • English
  • Français

Transcranial direct current stimulation for the outpatient treatment of poor-responder depressed patients

Published online by Cambridge University Press:  15 April 2020

B. Dell’Osso ,
S. Zanoni ,
R. Ferrucci ,
M. Vergari ,
F. Castellano ,
N. D’Urso ,
C. Dobrea ,
B. Benatti ,
C. Arici  and
A. Priori
...Show all authors
B. Dell’Osso*
Affiliation:
Dipartimento di Neuroscienze, Università degli Studi di Milano, Dipartimento di Salute Mentale Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
S. Zanoni
Affiliation:
Dipartimento di Neuroscienze, Università degli Studi di Milano, Dipartimento di Salute Mentale Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
R. Ferrucci
Affiliation:
Centro Clinico per le Neuronanotecnologie e la Neurostimolazione, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy U.O. Neurofisiopatologia, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
M. Vergari
Affiliation:
Centro Clinico per le Neuronanotecnologie e la Neurostimolazione, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy U.O. Neurofisiopatologia, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
F. Castellano
Affiliation:
Dipartimento di Neuroscienze, Università degli Studi di Milano, Dipartimento di Salute Mentale Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
N. D’Urso
Affiliation:
Dipartimento di Neuroscienze, Università degli Studi di Milano, Dipartimento di Salute Mentale Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
C. Dobrea
Affiliation:
Dipartimento di Neuroscienze, Università degli Studi di Milano, Dipartimento di Salute Mentale Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
B. Benatti
Affiliation:
Dipartimento di Neuroscienze, Università degli Studi di Milano, Dipartimento di Salute Mentale Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
C. Arici
Affiliation:
Dipartimento di Neuroscienze, Università degli Studi di Milano, Dipartimento di Salute Mentale Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
A. Priori
Affiliation:
Centro Clinico per le Neuronanotecnologie e la Neurostimolazione, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy U.O. Neurofisiopatologia, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy
A.C. Altamura
Affiliation:
Dipartimento di Neuroscienze, Università degli Studi di Milano, Dipartimento di Salute Mentale Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
*
*Corresponding author. Tel.: +02 5503 5994; fax: +02 5032 0310. E-mail address:bernardo.dellosso@unimi.it
Get access

Abstract

Transcranial direct current stimulation (tDCS) is a selective, painless, brain stimulation technique that allows the electric stimulation of specific cortical regions. TDCS has been recently used as investigational intervention for major depression and treatment resistant depression (TRD) with encouraging results. The present study was aimed to investigate the efficacy and tolerability of tDCS in major depressives with poor response to pharmacological treatment. Twenty-three depressed patients, with a diagnosis of major depressive disorder or bipolar disorder, were treated with augmentative tDCS for 5 days, two sessions per day in a blind-rater trial. The course of depressive symptoms was analyzed using repeated measures ANOVA for HAM-D and MADRS total scores. A qualitative analysis on the basis of the HAM-D response was performed as well. Both analyses were conducted at three time-points: T0 (baseline), T1 (endpoint tDCS) and T2 (end of the first week of follow-up). All patients completed the trial without relevant side-effects. A significant reduction of HAM-D and MADRS total scores was observed during the study (P<0.0001). Treatment response (endpoint HAM-D reduction ≥50%) was obtained by four patients (17.4%) at T1 and by seven patients (30.4%) at T2 and remission (endpoint HAM-D<8) by three patients (13.0%) at T1 and by four subjects (17.4%) at T2. Present findings support the efficacy and good tolerability of tDCS in the acute treatment of patients with TRD with clinical benefit being progressive and extended to the first week of follow-up. Further sham-controlled trials with longer follow-up are needed to confirm present results.

Keywords

Brain stimulationTranscranial direct current stimulation (tDCS)Treatment-resistant depression (TRD)Augmentation
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 7 , October 2012 , pp. 513 - 517
Copyright
Copyright © European Psychiatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder, 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.Google Scholar
Ardolino, G.Bossi, B.Barbieri, S.Priori, A.Non-synaptic mechanisms underlie the after-effects of cathodal transcutaneous direct current stimulation of the human brain. J Physiol. 2005; 568: 653–663.CrossRefGoogle ScholarPubMed
Arul-Anandam, A.P.Loo, C.Transcranial direct current stimulation: a new tool for the treatment of depression?. J Affect Disord. 2009; 117: 137–145.CrossRefGoogle ScholarPubMed
Bauer, M.Whybrow, P.C.Angst, J.Versiani, M.Moller, H.J.World federation of societies of biological psychiatry (WFSBP). Guidelines for biological treatment of unipolar depressive disorders, part 2: maintenance treatment of major depressive disorder and treatment of chronic depressive disorders and subthreshold depressions. World J Biol Psychiatry. 2002; 3: 69–86.CrossRefGoogle ScholarPubMed
Berlim, M.T.Turecki, G.Definition, assessment, and staging of treatment-resistant refractory major depression: a review of current concepts and methods. Can J Psychiatry. 2007; 52: 46–54.CrossRefGoogle ScholarPubMed
Boggio, P.S.Bermpohl, F.Vergara, A.O.Muniz, A.L.Nahas, F.H.Leme, P.B.et al.Go-no-go task performance improvement after anodal transcranial DC stimulation of the left dorsolateral prefrontal cortex in major depression. J Affect Disord. 2007; 101: 91–98.CrossRefGoogle ScholarPubMed
Boggio, P.S.Rigonatti, S.P.Ribeiro, R.B.Myczkowski, M.L.Nitsche, M.A.Pascual-Leone, A.et al.A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Int J Neuropsychopharmacol. 2008; 11: 249–254.CrossRefGoogle ScholarPubMed
Brunoni, A.R.Fraguas, R.Fregni, F.Pharmacological and combined interventions for the acute depressive episode: focus on efficacy and tolerability. Ther Clin Risk Manage. 2009; 5: 897–910.Google ScholarPubMed
Coupland, N.J.Ogilvie, C.J.Hegadoren, K.M.Seres, P.Hanstock, C.C.Allen, P.S.Decreased prefrontal myo-inositol in major depressive disorder. Biol Psychiatry. 2005; 57: 1526–1534.CrossRefGoogle ScholarPubMed
Dell’Osso, B.Priori, B.Altamura, A.C.Efficacy and safety of transcranial direct current stimulation (tDCS) in major depression. Biol Psychiatry. 2011; 69(8): e23–e24.CrossRefGoogle Scholar
Dell’Osso, B.Mundo, E.D’Urso, N.Pozzoli, S.Buoli, M.Ciabatti, M.et al.Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug-resistant bipolar depression. Bipolar Disord. 2009; 11: 76–81.CrossRefGoogle Scholar
Fava, M.Davidson, K.G.Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am. 1996; 19: 179–200.CrossRefGoogle ScholarPubMed
Fekadu, A.Wooderson, S.C.Markopoulo, K.Donaldson, C.Papadopoulos, A.Cleare, A.J.What happens to patients with treatment-resistant depression? A systematic review of medium to long-term outcome studies. J Affect Disord. 2009; 116: 4–11.CrossRefGoogle ScholarPubMed
Ferrucci, R.Bortolomasi, M.Vergari, M.Tadini, L.Salvoro, B.Giacopuzzi, M.et al.Transcranial direct current stimulation in severe, drug-resistant major depression. J Affect Disord. 2009; 118: 215–219.CrossRefGoogle Scholar
First, M.B.Spitzer, R.L.Gibbon, M.Williams, J.B.Structured clinical interview for DSM-IV TR axis I (SCID). Research Version. New York: New York State Psychiatric Institute; 2002.Google Scholar
Fregni, F.Boggio, P.S.Nitsche, M.A.Marcolin, M.A.Rigonatti, S.P.Pascual-Leone, A.Treatment of major depression with transcranial direct current stimulation. Bipolar Disord. 2006; 8: 203–204.CrossRefGoogle ScholarPubMed
Fregni, F.Boggio, P.S.Nitsche, M.A.Rigonatti, S.P.Pascual-Leone, A.Cognitive effects of repeated sessions of transcranial direct current stimulation in patients with depression. Depress Anxiety. 2006; 23: 482–484.CrossRefGoogle ScholarPubMed
Fritsch, B.Reis, J.Martinowich, K.Schambra, H.M.Ji, Y.Cohen, L.Direct current stimulation promotes BDNF-dependent synaptic plasticity: potential implications for motor learning. Neuron. 2010; 66: 198–204.CrossRefGoogle ScholarPubMed
Greden, J.F.The burden of disease for treatment-resistant depression. J Clin Psychiatry. 2001; 62 suppl. 16: 26–31.Google ScholarPubMed
Grimm, S.Beck, J.Schuepbach, D.Hell, D.Boesiger, P.Bermpohl, F.et al.Imbalance between left and right dorsolateral prefrontal cortex in major depression is linked to negative emotional judgment: an fMRI study in severe major depressive disorder. Biol Psychiatry. 2008; 63: 369–376.CrossRefGoogle ScholarPubMed
Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23: 56–62.CrossRefGoogle ScholarPubMed
Kennedy, S.H.Milev, R.Giacobbe, P.Ramasubbu, R.Lam, R.W.Parikh, S.V.et al.Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. IV. Neurostimulation therapies. J Affect Disord. 2009; 117 suppl. 1: S44–S53.CrossRefGoogle ScholarPubMed
Klein, N.Sacher, J.Wallner, H.Tauscher, J.Kasper, S.Therapy of treatment resistant depression: focus on the management of TRD with atypical antipsychotics. CNS Spectrums. 2004; 9: 823–832.CrossRefGoogle ScholarPubMed
Liebetanz, D.Nitsche, M.A.Tergau, F.Paulus, W.Pharmacological approach to the mechanisms of transcranial DC-stimulation-induced after-effects of human motor cortex excitability. Brain. 2002; 125: 2238–2247.CrossRefGoogle ScholarPubMed
Loo, C.K.Sachdev, P.Martin, D.Pigot, M.Alonzo, A.Malhi, G.S.et al.A double-blind, sham-controlled trial of transcranial direct current stimulation for the treatment of depression. Int J Neuropsychopharmacol. 2010; 13: 61–69.CrossRefGoogle ScholarPubMed
Montgomery, S.A.Asberg, M.A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134: 382–389.CrossRefGoogle ScholarPubMed
Nemeroff, C.B.Prevalence and management of treatment-resistant depression. J Clin Psychiatry. 2007; 68 suppl. 8: 17–25.Google ScholarPubMed
Nierenberg, A.A.DeCecco, L.M.Definitions of antidepressant treatment response, remission, non response, partial response, and other relevant outcomes: a focus on treatment-resistant depression. J Clin Psychiatry. 2001; 62 suppl. 16: 5–9.Google Scholar
Nitsche, M.A.Fricke, K.Henschke, U.Schlitterlau, A.Liebetanz, D.Lang, N.et al.Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans. J Physiol. 2003; 553: 293–301.CrossRefGoogle ScholarPubMed
Nitsche, M.A.Kuo, M.F.Karrasch, R.Wächter, B.Liebetanz, D.Paulus, W.Serotonin affects transcranial direct current-induced neuroplasticity in humans. Biol Psychiatry. 2009; 66(5): 503–508.CrossRefGoogle ScholarPubMed
Nitsche, M.A.Paulus, W.Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 527 Pt 3 2000 633–639.CrossRefGoogle ScholarPubMed
Nitsche, M.A.Paulus, W.Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology. 2001; 57: 1899–1901.CrossRefGoogle ScholarPubMed
Palm, U.Keeser, D.Schiller, C.Fintescu, Z.Reisinger, E.Baghai, T.C.et al.Transcranial direct current stimulation in a patient with therapy-resistant major depression. World J Biol Psychiatry. 2009; 10: 632–635.CrossRefGoogle Scholar
Paykel, E.S.Ramana, R.Cooper, Z.Hayhurst, H.Kerr, J.Barocka, A.Residual symptoms after partial remission: an important outcome in depression. Psychol Med. 1995; 25: 1171–1180.CrossRefGoogle ScholarPubMed
Pollo, A.Benedetti, F.The placebo response: neurobiological and clinical issues of neurological relevance. Prog Brain Res. 2009; 75: 283–294.CrossRefGoogle Scholar
Poreisz, C.Boros, K.Antal, A.Paulus, W.Safety aspects of transcranial direct current stimulation concerning healty subjects and patients. Brain Res Bull. 2007; 72: 208–214.CrossRefGoogle Scholar
Priori, A.Brain polarization in humans: a reappraisal of an old tool for prolonged non-invasive modulation of brain excitability. Clin Neurophysiol. 2003; 114: 589–595.CrossRefGoogle ScholarPubMed
Priori, A.Hallett, M.Rothwell, J.C.Repetitive transcranial magnetic stimulation or transcranial direct current stimulation. Brain Stimul. 2009; 2: 241–245.CrossRefGoogle ScholarPubMed
Rango, M.Cogiamanian, F.Marceglia, S.Barberis, B.Arighi, A.Biondetti, P.et al.Myoinositol content in the human brain is modified by transcranial direct current stimulation in a matter of minutes: a 1H-MRS study. Magn Reson Med. 2008; 60: 782–789.CrossRefGoogle Scholar
Rau, A.Grossheinrich, N.Palm, U.Pogarell, O.Padberg, F.Transcranial and deep brain stimulation approaches as treatment for depression. Clin EEG Neurosci. 2007; 38: 105–115.CrossRefGoogle ScholarPubMed
Rigonatti, S.P.Boggio, P.S.Myczkowski, M.L.Otta, E.Fiquer, J.T.Ribeiro, R.B.et al.Transcranial direct stimulation and fluoxetine for the treatment of depression. Eur Psychiatry. 2008; 23: 74–76.CrossRefGoogle ScholarPubMed
Sackeim, H.A.The definition and meaning of treatment-resistant depression. J Clin Psychiatry. 2001; 62 suppl. 16: 10–17.Google ScholarPubMed
Sackeim, H.A.Prudic, J.Nobler, M.S.Fitzsimons, L.Lisanby, S.H.Payne, N.et al.Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimul. 2008; 1: 71–83.CrossRefGoogle ScholarPubMed
Thase, M.E.Trivedi, M.Optimizing treatment outcomes for patients with depression and generalized anxiety disorder. Psychopharmacol Bull. 2002; 36 suppl. 2: 93–102.Google ScholarPubMed
von Knorring, L.Akerblad, A.C.Bengtsson, F.Carlsson, A.Ekselius, L.Cost of depression: effect of adherence and treatment response. Eur Psychiatry. 2006; 21: 349–354.CrossRefGoogle ScholarPubMed
Walter, H.Wolf, R.C.Spitzer, M.Vasic, N.Increased left prefrontal activation in patients with unipolar depression: an event-related, parametric, performance-controlled fMRI study. J Affect Disord. 2007; 101: 175–185.CrossRefGoogle ScholarPubMed
Welge, J.A.Keck, P.E.Moderators of placebo response to antipsychotic treatment in patients with schizophrenia: a meta-regression. Psychopharmacology. 2003; 166: 1–10.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.