tDCS Efficacy in Depression: Does It Work with Medication?

Author Names

Jingying Wang, Huichun Luo, Rasmus Schülke, Xinyi Geng, Barbara J. Sahakian and Shouyan Wang

Published Date: November 2021

Journal Name: BMC Medicine

Abstract

This systematic review and meta-analysis examined the efficacy of transcranial direct current stimulation (tDCS) as both a standalone treatment and in combination with antidepressant medications, psychotherapy, and electroconvulsive therapy (ECT) for major depressive disorder (MDD). The analysis included 12 randomized, sham-controlled trials, totaling 455 patients. The study found that tDCS combined with medication significantly improved depression scores and response rates, while tDCS alone or combined with psychotherapy or ECT did not show significant benefits.

Key Concepts

• Transcranial Direct Current Stimulation (tDCS): A non-invasive brain stimulation technique that modulates neuronal activity and has been explored as a treatment for depression.

• Major Depressive Disorder (MDD): A mental health condition characterized by persistent feelings of sadness, loss of interest, and various physical and emotional problems.

• Combination Therapy: The use of tDCS in conjunction with antidepressants, psychotherapy, or ECT to enhance treatment outcomes.

• Literature Review: Previous studies have shown mixed results regarding the effectiveness of tDCS, particularly when combined with other treatments. This study aims to clarify these findings through a comprehensive meta-analysis.

Procedure Highlights - Research Methodology

1. Study Design: Systematic review and meta-analysis following PRISMA guidelines, including 12 randomized, sham-controlled trials.

2. Participants: 455 patients with MDD, with 251 assigned to active tDCS and 204 to sham treatment groups.

3. tDCS Intervention: Treatment protocols varied across studies, with most applying tDCS to the dorsolateral prefrontal cortex (dlPFC) over 10-20 sessions.

4. Outcome Measures: Depression severity (using HDRS or MADRS), dropout rates, response rates, and remission rates were analyzed.

Results - Findings of the Research

• Depression Scores: tDCS combined with medication significantly reduced depression scores compared to sham treatment (Hedges’ g = −0.855, p < 0.001).

• Response Rate: The response rate was significantly higher in the tDCS + medication group compared to sham (OR = 2.7, p = 0.006).

• Remission and Dropout Rates: No significant differences were found in remission or dropout rates between active and sham groups across all treatment strategies.

• Heterogeneity: High heterogeneity was noted in studies using tDCS alone, suggesting variability in treatment efficacy depending on study design and patient characteristics.

Discussion and Conclusion of the Research

The study concludes that tDCS, when combined with antidepressant medication, is an effective treatment for reducing depression severity and increasing response rates in patients with MDD.

The findings suggest that tDCS alone or with psychotherapy or ECT does not significantly improve depression outcomes. Future research should focus on optimizing treatment protocols and exploring the long-term effects of tDCS, particularly in combination with selective serotonin reuptake inhibitors (SSRIs).

Link to the Original Paper

Is transcranial direct current stimulation, alone or in combination with antidepressant medications or psychotherapies, effective in treating major depressive disorder? A systematic review and meta-analysis

Author Information

• Jingying Wang: Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.

• Huichun Luo: Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

• Rasmus Schülke: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.

• Xinyi Geng: Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.

• Barbara J. Sahakian: Department of Psychiatry, University of Cambridge, Cambridge, UK.

• Shouyan Wang: Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.

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