Guidelines for tDCS in Psychiatry: A Clinical Practice Review

Author Names

Vanteemar S. Sreeraj, Shyam Sundar Arumugham, Ganesan Venkatasubramanian

Published Date: February 2023

Journal Name: Indian Journal of Psychiatry

Abstract

This clinical practice guideline (CPG) provides an in-depth overview of the use of transcranial direct current stimulation (tDCS) in the treatment of various psychiatric disorders. It outlines the mechanisms of action, safety protocols, and evidence-based recommendations for using tDCS in conditions such as major depressive disorder (MDD), schizophrenia, obsessive-compulsive disorder (OCD), and substance use disorders. The guideline emphasizes the non-invasive nature, safety, and potential of tDCS as an adjunctive treatment in psychiatric practice, especially in treatment-resistant cases.

Key Concepts

• Transcranial Direct Current Stimulation (tDCS): A non-invasive neuromodulation technique that uses low-intensity electrical currents to modulate brain activity, often used in psychiatric and neurological treatments.

• Clinical Practice Guidelines (CPG): Evidence-based recommendations that guide clinicians in applying tDCSapplying for treating various psychiatric disorders.

• Neuroplasticity: The brain’s ability to reorganize itself by forming new neural connections, which tDCS may enhance.

• Literature Review: The guideline reviews existing research and summarises the effectiveness of tDCS in different psychiatric conditions, focusing on the quality of evidence supporting its use.

Procedure Highlights - Research Methodology

1. Study Design: The guideline is based on a systematic review of the literature, clinical trials, and expert consensus on the use of tDCS in psychiatry.

2. Participants: The guideline references multiple studies involving patients with psychiatric conditions like MDD, schizophrenia, OCD, and substance use disorders.

3. tDCS Application: Recommendations for tDCS application include protocols for electrode placement, stimulation parameters, and patient monitoring to ensure safety and efficacy.

4. Outcome Measures: The guideline categorizes the evidence supporting tDCS use into three levels: Level A (definitely effective), Level B (probably effective), and Level C (possibly effective), based on clinical outcomes from various studies.

Results - Findings of the Research

• Major Depressive Disorder (MDD): tDCS is classified as Level A (definitely effective) for treating MDD, particularly in cases of treatment-resistant depression. The evidence supports its use as an adjunct to standard antidepressant treatments.

• Schizophrenia: tDCS shows promise in managing treatment-resistant symptoms, such as auditory verbal hallucinations and negative symptoms, with recommendations based on Level B evidence (probably effective).

• Obsessive-Compulsive Disorder (OCD): The use of tDCS for OCD is supported by Level C evidence (possibly effective), with mixed results in different studies.

• Substance Use Disorders: tDCS is recommended as a potentially effective treatment for reducing cravings and relapse in alcohol and tobacco dependence, with evidence categorized as Level B.

Discussion and Conclusion of the Research

The clinical practice guideline concludes that tDCS is a viable and safe option for treating various psychiatric disorders, particularly in cases where conventional treatments are ineffective. The guideline highlights the importance of following standardized protocols to maximize the therapeutic benefits of tDCS. It also emphasizes the need for further research to explore its long-term efficacy and potential applications in other psychiatric conditions.

Link to the Original Paper

Clinical practice guidelines for the use of transcranial direct current stimulation in psychiatry

Author Information

• Vanteemar S. Sreeraj: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

• Shyam Sundar Arumugham: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

• Ganesan Venkatasubramanian: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

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