tDCS for MDD: Real-World Symptom Reduction Outcomes

Author Names

Margus Lõokene, Nikola Markov, Mika Nikander, Tuomas Neuvonen, Dancho Dilkov

Published Date: March 2022

Journal Name: Journal of Affective Disorders Reports

Abstract

This real-world study assesses the effectiveness and tolerability of transcranial direct current stimulation (tDCS) in treating major depressive disorder (MDD). A total of 462 patients from seven countries were included, with 410 completing the treatment. The results indicated that 54.9% of patients achieved a complete clinical response (CCR), 19.5% reached remission, and 94.6% exhibited a minimal clinically important difference (MCID). The study highlights tDCS as a viable treatment option for MDD, with good tolerability and potential use as either a standalone treatment or in conjunction with antidepressant medication.

Key Concepts

• Transcranial Direct Current Stimulation (tDCS): A non-invasive neuromodulation technique that uses low-intensity electrical currents to modulate brain activity, particularly in the dorsolateral prefrontal cortex (DLPFC).

• Major Depressive Disorder (MDD): A prevalent and often treatment-resistant psychiatric disorder characterized by persistent feelings of sadness and loss of interest.

• Real-World Study: Unlike randomized controlled trials (RCTs), this study reflects the effectiveness of tDCS in routine clinical practice, offering insights into its practical application and patient outcomes.

• Literature Review: Previous studies have established tDCS as an effective treatment for MDD in RCT settings, but real-world evidence is sparse, prompting this study to explore its effectiveness in everyday clinical environments.

Procedure Highlights - Research Methodology

1. Study Design: A retrospective, real-world study involving 462 patients from seven countries who received tDCS as part of routine clinical practice.

2. Participants: Out of 462 patients enrolled, 410 completed the treatment, with 57.9% being female and the median age being 39 years. Patients had varying degrees of depression severity and were either using psychotropics or not during the treatment.

3. tDCS Intervention: The tDCS treatment was administered using the Sooma tDCS™ device with a current of 2 mA over the DLPFC (F3 for anode, F4 for cathode) for 30 minutes per session, typically five times per week for 2-3 weeks, followed by maintenance as needed.

4. Outcome Measures: Depression severity was assessed using validated scales such as the Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), and Montgomery-Asberg Depression Rating Scale (MADRS), with primary outcomes including CCR and remission rates.

Results - Findings of the Research

• Clinical Response and Remission: A complete clinical response (CCR) was observed in 54.9% of patients, with 19.5% achieving remission. The effectiveness of tDCS was evident across all severity levels, although patients without concomitant psychotropic use had better outcomes.

• Adverse Effects: The treatment was well-tolerated, with the most common side effects being skin itching (44.1%), headache (24.6%), and skin redness (17.8%). Hypomania was reported in two patients (0.5%), both of whom were also using antidepressants.

• Predictors of Outcomes: Patients with milder depression and those not using psychotropics were more likely to achieve CCR and remission, suggesting that these factors may influence the effectiveness of tDCS.

Discussion and Conclusion of the Research

The study supports the use of tDCS as a safe and effective treatment for MDD in a real-world clinical setting. It highlights the potential for tDCS to be used both as a standalone treatment and in conjunction with antidepressants, particularly for patients with milder forms of depression or those not taking psychotropics. The findings underscore the importance of further research to optimize tDCS protocols, especially for patients with more severe depression or those using psychotropics.

Link to the Original Paper

Reduction of symptoms in patients with major depressive disorder after transcranial direct current stimulation treatment: A real-world study

Author Information

• Margus Lõokene: The North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia.

• Nikola Markov: Private Mental Health Centre, Plovdiv, Bulgaria.

• Mika Nikander: Sooma Oy, Helsinki, Finland.

• Tuomas Neuvonen: Sooma Oy, Helsinki, Finland.

• Dancho Dilkov: Department of Psychiatry and Military Psychology, Military Medical Academy, Sofia, Bulgaria.

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