Safety and Efficacy of tDCS in OCD: Open-Label Trial Findings

Author Names

Satish Kumar, Nand Kumar, Rohit Verma

Published Date: July 2019

Journal Name: Indian Journal of Psychiatry

Abstract

This open-label trial evaluates the safety and efficacy of transcranial direct current stimulation (tDCS) as an adjunctive treatment in patients with treatment-resistant obsessive-compulsive disorder (OCD). Conducted on 20 patients at AIIMS, New Delhi, the study involved 20 sessions of tDCS targeting the supplementary motor area (SMA). The findings revealed significant improvements in OCD symptoms, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression (CGI) scale, with minimal side effects reported.

Key Concepts

• Obsessive-Compulsive Disorder (OCD): A chronic psychiatric disorder characterized by intrusive thoughts (obsessions) and repetitive behaviours (compulsions).

• Treatment-Resistant OCD: A form of OCD that does not respond to standard pharmacological and psychotherapeutic treatments, necessitating alternative approaches.

• Transcranial Direct Current Stimulation (tDCS): A non-invasive neuromodulation technique that applies low-intensity electrical currents to the brain, aiming to modulate neural activity and reduce symptoms.

• Literature Review: The study builds on prior research indicating the potential of tDCS in modulating brain circuits implicated in OCD, with a focus on its use as an adjunct to conventional treatments.

Procedure Highlights - Research Methodology

1. Study Design: Open-label trial conducted at AIIMS, New Delhi, involving 20 patients diagnosed with treatment-resistant OCD.

2. Participants: 20 right-handed patients (11 males, 9 females) aged 18-45 years, diagnosed with OCD as per ICD-10 criteria and resistant to standard treatments. Patients with comorbid psychiatric/neurological disorders, severe depression, or substance abuse were excluded.

3. tDCS Intervention: The tDCS treatment involved 20 sessions over 10 days (5 days per week), with 2 mA current applied for 20 minutes per session. The cathode was placed over the SMA and the anode over the right occipital area.

4. Outcome Measures: Primary outcome measured by the Y-BOCS score, with secondary outcomes including CGI, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and side effect checklist.

Results - Findings of the Research

• OCD Symptom Improvement: The study found a significant decrease in Y-BOCS scores (mean reduction of 5.30 points, p=0.008) after 20 sessions of tDCS. An improvement of over 35% in Y-BOCS scores was observed in 15% of participants.

• Clinical Global Impression (CGI): Significant reductions were noted in CGI-S (symptom severity) and CGI-I (improvement) scores, indicating overall clinical improvement.

• Depression and Anxiety: Significant reductions were also observed in HAM-D and HAM-A scores, suggesting improvements in comorbid depressive and anxiety symptoms.

• Side Effects: Mild side effects included headaches and tingling sensations, with no participants dropping out due to adverse effects.

Discussion and Conclusion of the Research

The findings suggest that tDCS, particularly cathodal stimulation at the SMA, is a safe and effective adjunctive treatment for patients with treatment-resistant OCD. The study underscores the potential of tDCS to improve OCD symptoms, with minimal side effects, making it a promising option for patients unresponsive to conventional therapies. However, the open-label design and small sample size limit the generalisability of the results, highlighting the need for larger, controlled trials.

Link to the Original Paper

Safety and efficacy of adjunctive transcranial direct current stimulation in treatment-resistant obsessive-compulsive disorder: An open-label trial

Author Information

• Satish Kumar: Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.

• Nand Kumar: Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.

• Rohit Verma: Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.

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