Hostname: page-component-5b777bbd6c-6lqsf Total loading time: 0 Render date: 2025-06-21T06:51:32.007Z Has data issue: false hasContentIssue false
  • English
  • Français

Augmentative transcranial direct current stimulation (tDCS) in poor responder depressed patients: a follow-up study

Published online by Cambridge University Press:  20 August 2013

Bernardo Dell'Osso ,
Cristina Dobrea ,
Chiara Arici ,
Beatrice Benatti ,
Roberta Ferrucci ,
Maurizio Vergari ,
Alberto Priori  and
A. Carlo Altamura
Bernardo Dell'Osso*
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
Cristina Dobrea
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
Chiara Arici
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
Beatrice Benatti
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
Roberta Ferrucci
Affiliation:
Center of Neurostimulation, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
Maurizio Vergari
Affiliation:
Center of Neurostimulation, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
Alberto Priori
Affiliation:
Center of Neurostimulation, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
A. Carlo Altamura
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
*
*Address for correspondence: Dr. Bernardo Dell'Osso, MD, Assistant Professor of Psychiatry, Department of Psychiatry, University of Milan; Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy. (Email bernardo.dellosso@unimi.it)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Transcranial direct current stimulation (tDCS) is a non-invasive neurostimulation technique that has received increasing interest in the area of mood disorders over the last several years. While acute, double-blind, sham-controlled studies have already reported positive findings in terms of efficacy and safety for tDCS, follow-up data are lacking. This need prompted the present follow-up study, which assesses post-acute effects of tDCS (no maintenance stimulation was performed), in the mid-term, in a sample of major depressives.

Methods

After completing an acute, open trial of tDCS, 23 outpatients with either major depressive disorder or bipolar disorder entered a naturalistic follow-up (T1) with clinical evaluations at one week (T2), 1 month (T3), and 3 months (T4). A quantitative analysis of Hamilton Depression Rating Scale (HAM-D), Montgomery–Asberg Depression Rating Scale (MADRS), and Young Mania Rating Scale (YMRS) total scores, through repeated measures analysis of variance (ANOVA) (T1–T4) and paired t-test for comparing specific time points (T1–T2, T2–T3, and T3–T4), was performed. In addition, a qualitative analysis on the basis of treatment response and remission (HAM-D) was performed.

Results

Even though a progressive reduction of follow-up completers was observed from T2 to T4 (95.6% at T2, 65.2% at T3, and 47.8% at T4), the antidepressant effects of acute tDCS persisted over 3 months in almost half of the sample. Of note, no post-acute side effects emerged during the follow-up observation. The most frequent causes of drop-out from this study included major modifications in therapeutic regimen (30%) and poor adherence to follow-up visits (17%).

Conclusions

In this mid-term, open, follow-up study, tDCS showed mixed results. Further controlled studies are urgently needed to assess its effects beyond the acute phase.

Keywords

Bipolar disorderfollow-up observationmajor depressive disorderpoor responsetranscranial direct current stimulation (tDCS)
Type
Original Research
Information
CNS Spectrums , Volume 19 , Issue 4 , August 2014 , pp. 347 - 354
Copyright
Copyright © Cambridge University Press 2013 

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.)

Article purchase

Temporarily unavailable

Footnotes

The authors thank Dr. Filippo Castellano, MD, and Dr. Massimiliano Buoli, MD, for their support.

References

1.WHO. The world health report. Chap. 2.4, Geneva, Switzerland: World Health Organization; 2001. Available at http://www.who.int/whr/2001/en/whr01_en.pdf.Google Scholar
2.Nemeroff, CB. Prevalence and management of treatment resistant depression. J Clin Psychiatry. 2007; 68(suppl. 8): 17–25.Google ScholarPubMed
3.Sackeim, HA. The definition and meaning of treatment-resistant depression. J Clin Psychiatry. 2001; 62(suppl. 16): 10–17.Google ScholarPubMed
4.Carvajal, C. Poor response to treatment: beyond medication. Dialogues Clin Neurosci. 2004; 6: 93–103.CrossRefGoogle ScholarPubMed
5.Bauer, M, Whybrow, PC, Angst, J, etal. 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
6.Kennedy, SH, Milev, R, Giacobbe, P, etal. 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 Scholar
7.Fregni, F, Boggio, PS, Nitsche, MA, etal. Treatment of major depression with transcranial direct current stimulation. Bipolar Disord. 2006; 8: 203–204.CrossRefGoogle ScholarPubMed
8.Boggio, PS, Rigonatti, SP, Ribeiro, RB, etal. 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
9.Rigonatti, SP, Boggio, PS, Myczkowski, ML, etal. Transcranial direct stimulation and fluoxetine for the treatment of depression. Eur Psychiatry. 2008; 23: 74–76.CrossRefGoogle ScholarPubMed
10.Ferrucci, R, Bortolomasi, M, Vergari, M, etal. Transcranial direct current stimulation in severe, drug-resistant major depression. J Affect Disord. 2009; 118: 215–219.CrossRefGoogle ScholarPubMed
11.Loo, CK, Sachdev, P, Martin, D, etal. 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
12.Brunoni, AR, Ferrucci, R, Bortolomasi, M, etal. Transcranial direct current stimulation (tDCS) in unipolar vs. bipolar depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2011; 35: 96–101.CrossRefGoogle ScholarPubMed
13.Blumberger, DM, Tran, LC, Fitgerald, PB, Hoy, KE, Daskalakis, ZJ. A randomized double-blind sham-controlled study of transcranial direct current stimulation for treatment-resistant major depression. Front Psychiatry. 2012; 3: 74.CrossRefGoogle ScholarPubMed
14.Loo, CK, Alonzo, A, Martin, D, etal. Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial. Br J Psychiatry. 2012; 200: 52–59.CrossRefGoogle ScholarPubMed
15.Palm, U, Schiller, C, Fintescu, Z, etal. Transcranial direct current stimultation in treatment resistant depression: a randomized double-blind, placebo-controlled study. Brain Stimul. 2012; 5(3): 242–251.CrossRefGoogle Scholar
16.Nitsche, MA, Paulus, W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000; 527: 633–639.CrossRefGoogle ScholarPubMed
17.Nitsche, MA, Paulus, W. Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology. 2001; 57: 1899–1901.CrossRefGoogle ScholarPubMed
18.Grimm, S, Beck, J, Schuepbach, D, etal. 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
19.Dell'Osso, B, Zanoni, S, Ferrucci, R, etal. Transcranial direct current stimulation for the outpatient treatment of poor-responder depressed patients. Eur Psychiatry. 2012; 27(7): 513–517.CrossRefGoogle ScholarPubMed
20.Dell'Osso, B, Priori, A, Altamura, AC. Efficacy and safety of transcranial direct current stimulation in major depression. Biol Psychiatry. 2011; 69: e23–24.CrossRefGoogle ScholarPubMed
21.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
22.Liebetanz, D, Fregni, F, Monte-Silva, KK, etal. After-effects of transcranial direct current stimulation (tDCS) on cortical spreading depression. Neurosci Lett. 2006; 398: 85–90.CrossRefGoogle ScholarPubMed
23.Kalu, UG, Sexton, CE, Loo, CK, Ebmeier, KP. Transcranial direct current stimulation in the treatment of major depression: a meta-analysis. Psychol Med. 2012; 42(9): 1791–2000.CrossRefGoogle ScholarPubMed
24.Brunoni, AR, Valiengo, L, Baccaro, A, etal. The sertraline vs. electrical current therapy for treating depression clinical study: results from a factorial, randomized, controlled trial. JAMA Psychiatry. 2013; 70(4): 383–391.CrossRefGoogle ScholarPubMed
25.Martin, DM, Alonzo, A, Ho, KA, etal. Continuation transcranial direct current stimulation for the prevention of relapse in major depression. J Affect Disord. 2013; 144(3): 274–278.CrossRefGoogle ScholarPubMed
26.Valiengo, L, Benseñor, IM, Goulart, AC, etal. The sertraline versus electrical current therapy for treating depression clinical study (select-tdcs): results of the crossover and follow-up phases. Depress Anxiety. 2013; 30(7): 646–653.CrossRefGoogle ScholarPubMed
27.Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23: 56–62.CrossRefGoogle ScholarPubMed
28.Montgomery, SA, Asberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134: 382–389.CrossRefGoogle ScholarPubMed
29.Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978; 133: 429–435.CrossRefGoogle ScholarPubMed
30.Bech, P, Allerup, P, Gram, LF, etal. The Hamilton depression scale. Evaluation of objectivity using logistic models. Acta Psychiatr Scand. 1981; 63: 290–299.CrossRefGoogle ScholarPubMed
31.Nierenberg, AA, DeCecco, LM. 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
32.Martin, DM, Alonzo, A, Mitchell, PB, etal. Fronto-extracephalic transcranial direct current stimulation as a treatment for major depression: An open-label pilot study. J Affect Disord. 2011; 134(1–3): 459–463.CrossRefGoogle ScholarPubMed
33.Gálvez, V, Alonzo, A, Martin, D, etal. Hypomania induction in a patient with bipolar II disorder by transcranial direct current stimulation (tDCS). J ECT. 2011; 27(3): 256–258.CrossRefGoogle Scholar
34.O'Reardon, JP, Solvason, HB, Janicak, PG, etal. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007; 62: 1208–1216.CrossRefGoogle ScholarPubMed
35.Groves, DA, Brown, VJ. Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neurosci Biobehav Rev. 2005; 29: 493–500.CrossRefGoogle ScholarPubMed
36.Lozano, AM, Giacobbe, P, Hamani, C, etal. A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment-resistant depression. J Neurosurg. 2012; 116(2): 315–322.CrossRefGoogle ScholarPubMed
37.Sackeim, HA, Haskett, RF, Mulsant, BH, etal. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001; 285: 1299–1307.CrossRefGoogle ScholarPubMed
38.Navarro, V. Improving medication compliance in patients with depression: use of orodispersible tablets. Adv Ther. 2010; 27: 785–795.CrossRefGoogle ScholarPubMed
39.Gourion, D, Galinowski, A, Baraille, L, Picard, H. [Switch antidepressants: when? how? why?] Encephale. 2011; 37(suppl 1): S50–S57. In French.CrossRefGoogle Scholar
40.Brunoni, AR, Ferrucci, R, Bortolomasi, M, etal. Interactions between transcranial direct current stimulation (tDCS) and pharmacological treatments in major depression. Eur Psychiatry. In press. DOI: 10.1016/j.eurpsy.2012.09.001.Google Scholar
41.Brunoni, AR, Fraguas, R, Fregni, F. Pharmacological and combined interventions for the acute depressive episode: focus on efficacy and tolerability. Ther Clin Risk Manag. 2009; 5: 897–910.Google ScholarPubMed