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Valter Y, Rapallo F, Burlando B, Crossen M, Baeken C, Datta A, Deblieck C. Efficacy of noninvasive brain stimulation and neuronavigation for major depressive disorder: a systematic review and meta-analysis. Expert Rev Med Devices 2024. [PMID: 38902968 DOI: 10.1080/17434440.2024.2370820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are increasingly used for major depressive disorder (MDD). Most tDCS and rTMS studies target the left dorsolateral prefrontal cortex, either with or without neuronavigation. We examined the effect of rTMS and tDCS, and the added value of neuronavigation in the treatment of MDD. METHODS A search on PubMed, Embase, and Cochrane databases for rTMS or tDCS randomized controlled trials of MDD up to 1 February 2023, yielded eighty-nine studies. We then performed meta-analyses comparing tDCS efficacy to non-neuronavigated rTMS, tDCS to neuronavigated rTMS, and neuronavigated rTMS to non-neuronavigated rTMS. We assessed the significance of the effect in subgroups and in the whole meta-analysis with a z-test and subgroup differences with a chi-square test. RESULTS We found small-to-medium effects of both tDCS and rTMS on MDD, with a slightly greater effect from rTMS. No significant difference was found between neuronavigation and non-neuronavigation. CONCLUSION Although both tDCS and rTMS are effective in treating MDD, many patients do not respond. Additionally, current neuronavigation methods are not significantly improving MDD treatment. It is therefore imperative to seek personalized methods for these interventions.
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Affiliation(s)
- Yishai Valter
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
- Department of Biomedical Engineering, City College of the City University of New York, New York, NY
| | - Fabio Rapallo
- Faculty of Economics, University of Genoa, Genova, IT
| | | | - Miah Crossen
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
| | - Chris Baeken
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium
- Department of Psychiatry, University Hospital (UZBrussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Abhishek Datta
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
- Department of Biomedical Engineering, City College of the City University of New York, New York, NY
| | - Choi Deblieck
- Lab for Equilibrium Investigations and Aerospace (LEIA), University of Antwerp, Belgium
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Gomez-Tames J, Fernández-Corazza M. Perspectives on Optimized Transcranial Electrical Stimulation Based on Spatial Electric Field Modeling in Humans. J Clin Med 2024; 13:3084. [PMID: 38892794 PMCID: PMC11172989 DOI: 10.3390/jcm13113084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Transcranial electrical stimulation (tES) generates an electric field (or current density) in the brain through surface electrodes attached to the scalp. Clinical significance has been demonstrated, although with moderate and heterogeneous results partly due to a lack of control of the delivered electric currents. In the last decade, computational electric field analysis has allowed the estimation and optimization of the electric field using accurate anatomical head models. This review examines recent tES computational studies, providing a comprehensive background on the technical aspects of adopting computational electric field analysis as a standardized procedure in medical applications. Methods: Specific search strategies were designed to retrieve papers from the Web of Science database. The papers were initially screened based on the soundness of the title and abstract and then on their full contents, resulting in a total of 57 studies. Results: Recent trends were identified in individual- and population-level analysis of the electric field, including head models from non-neurotypical individuals. Advanced optimization techniques that allow a high degree of control with the required focality and direction of the electric field were also summarized. There is also growing evidence of a correlation between the computationally estimated electric field and the observed responses in real experiments. Conclusions: Computational pipelines and optimization algorithms have reached a degree of maturity that provides a rationale to improve tES experimental design and a posteriori analysis of the responses for supporting clinical studies.
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Affiliation(s)
- Jose Gomez-Tames
- Department of Medical Engineering, Graduate School of Engineering, Chiba University, Chiba 263-8522, Japan
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
| | - Mariano Fernández-Corazza
- LEICI Institute of Research in Electronics, Control and Signal Processing, National University of La Plata, La Plata 1900, Argentina
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Zhang D, Zhao B, Sun X, Ding K, Sun J, Tao S. High-definition transcranial direct current stimulation (HD-tDCS) in major depressive disorder with anxious distress-a study protocol for a double-blinded randomized sham-controlled trial. Trials 2024; 25:320. [PMID: 38750599 PMCID: PMC11094846 DOI: 10.1186/s13063-024-08157-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Comorbid anxiety disorders and anxious distress are highly prevalent among individuals with major depressive disorder (MDD). The presence of the DSM-5 anxious distress specifier (ADS) has been associated with worse treatment outcomes and chronic disease course. Few studies have evaluated the therapeutic effects of High-definition transcranial direct current stimulation (HD-tDCS) on depressive and anxiety symptoms among MDD patients with ADS. The current randomized controlled trial aims to assess the efficacy of HD-tDCS as an augmentation therapy with antidepressants compared to sham-control in subjects of MDD with ADS. METHODS MDD patients with ADS will be recruited and randomly assigned to the active HD-tDCS or sham HD-tDCS group. In both groups, patients will receive the active or sham intervention in addition to their pre-existing antidepressant therapy, for 2 weeks with 5 sessions per week, each lasting 30 min. The primary outcome measures will be the change of depressive symptoms, clinical response, and the remission rate as measured with the 17-item Hamilton Depression Rating Scale (HDRS-17) before and after the intervention and at the 2nd and 6th week after the completed intervention. Secondary outcome measures include anxiety symptoms, cognitive symptoms, disability assessment, and adverse effects. DISCUSSION The HD-tDCS applied in this trial may have treatment effects on MDD with ADS and have minimal side effects. TRIAL REGISTRATION The trial protocol is registered with www.chictr.org.cn under protocol registration number ChiCTR2300071726. Registered 23 May 2023.
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Affiliation(s)
- Danwei Zhang
- Department of Psychology, Zhenjiang Mental Health Center, No. 199 Tuanshan Road, Zhenjiang, Jiangsu, 212001, China
| | - Bei Zhao
- Department of Psychology, Zhenjiang Mental Health Center, No. 199 Tuanshan Road, Zhenjiang, Jiangsu, 212001, China
| | - Xue Sun
- Department of Psychiatry, Zhenjiang Mental Health Center, No. 199 Tuanshan Road, Zhenjiang, Jiangsu, 212001, China
| | - Kaimo Ding
- Department of Psychology, Zhenjiang Mental Health Center, No. 199 Tuanshan Road, Zhenjiang, Jiangsu, 212001, China
| | - Jingjing Sun
- Department of Psychology, Zhenjiang Mental Health Center, No. 199 Tuanshan Road, Zhenjiang, Jiangsu, 212001, China.
| | - Sheng Tao
- Department of Psychiatry, Zhenjiang Mental Health Center, No. 199 Tuanshan Road, Zhenjiang, Jiangsu, 212001, China
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Ruffini G, Salvador R, Castaldo F, Baleeiro T, Camprodon JA, Chopra M, Cappon D, Pascual-Leone A. Multichannel tDCS with Advanced Targeting for Major Depressive Disorder: A Tele-Supervised At-Home Pilot Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.04.24303508. [PMID: 38496607 PMCID: PMC10942536 DOI: 10.1101/2024.03.04.24303508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Introduction Proof-of-principle human studies suggest that transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) may improve depression severity. This open-label multicenter study tested remotely supervised multichannel tDCS delivered at home in patients (N=35) with major depressive disorder (MDD). The primary aim was to assess the feasibility and safety of our protocol. As an exploratory aim, we evaluated therapeutic efficacy: the primary efficacy measure was the median percent change from baseline to the end of the 4-week post-treatment follow-up period in the observer-rated Montgomery-Asberg Depression Mood Rating Scale (MADRS). Methods Participants received 37 at-home stimulation sessions (30 minutes each) of specifically designed multichannel tDCS targeting the left DLPFC administered over eight weeks (4 weeks of daily treatments plus 4 weeks of taper), with a follow-up period of 4 weeks following the final stimulation session. The stimulation montage (electrode positions and currents) was optimized by employing computational models of the electric field generated by multichannel tDCS using available structural data from a similar population (group optimization). Conducted entirely remotely, the study employed the MADRS for assessment at baseline, at weeks 4 and 8 during treatment, and at 4-week follow-up visits. Results 34 patients (85.3% women) with a mean age of 59 years, a diagnosis of MDD according to DSM-5 criteria, and a MADRS score ≥20 at the time of study enrolment completed all study visits. At baseline, the mean time since MDD diagnosis was 24.0 (SD 19.1) months. Concerning compliance, 85% of the participants (n=29) completed the complete course of 37 stimulation sessions at home, while 97% completed at least 36 sessions. No detrimental effects were observed, including suicidal ideation and/or behavior. The study observed a median MADRS score reduction of 64.5% (48.6, 72.4) 4 weeks post-treatment (Hedge's g = -3.1). We observed a response rate (≥ 50% improvement in MADRS scores) of 72.7% (n=24) from baseline to the last visit 4 weeks post-treatment. Secondary measures reflected similar improvements. Conclusions These results suggest that remotely supervised and supported multichannel home-based tDCS is safe and feasible, and antidepressant efficacy motivates further appropriately controlled clinical studies.
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Borrione L, Cavendish BA, Aparicio LVM, Luethi MS, Goerigk S, Ramos MRF, Moran NKS, Carneiro AM, Valiengo L, Moura DO, de Souza JP, Batista MP, Aparecida da Silva V, Klein I, Suen P, Gallucci-Neto J, Padberg F, Razza LB, Vanderhasselt MA, Lotufo PA, Bensenor IM, Fregni F, Brunoni AR. Home-Use Transcranial Direct Current Stimulation for the Treatment of a Major Depressive Episode: A Randomized Clinical Trial. JAMA Psychiatry 2024; 81:329-337. [PMID: 38170541 PMCID: PMC10765312 DOI: 10.1001/jamapsychiatry.2023.4948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 01/05/2024]
Abstract
Importance Transcranial direct current stimulation (tDCS) is moderately effective for depression when applied by trained staff. It is not known whether self-applied tDCS, combined or not with a digital psychological intervention, is also effective. Objective To determine whether fully unsupervised home-use tDCS, combined with a digital psychological intervention or digital placebo, is effective for a major depressive episode. Design, Setting, and Participants This was a double-blinded, sham-controlled, randomized clinical trial with 3 arms: (1) home-use tDCS plus a digital psychological intervention (double active); (2) home-use tDCS plus digital placebo (tDCS only), and (3) sham home-use tDCS plus digital placebo (double sham). The study was conducted between April 2021 and October 2022 at participants' homes and at Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. Included participants were aged 18 to 59 years with major depression and a Hamilton Depression Rating Scale, 17-item version (HDRS-17), score above 16, a minimum of 8 years of education, and access to a smartphone and internet at home. Exclusion criteria were other psychiatric disorders, except for anxiety; neurologic or clinical disorders; and tDCS contraindications. Interventions tDCS was administered in 2-mA, 30-minute prefrontal sessions for 15 consecutive weekdays (1-mA, 90-second duration for sham) and twice-weekly sessions for 3 weeks. The digital intervention consisted of 46 sessions based on behavioral therapy. Digital placebo was internet browsing. Main Outcomes and Measures Change in HDRS-17 score at week 6. Results Of 837 volunteers screened, 210 participants were enrolled (180 [86%] female; mean [SD] age, 38.9 [9.3] years) and allocated to double active (n = 64), tDCS only (n = 73), or double sham (n = 73). Of the 210 participants enrolled, 199 finished the trial. Linear mixed-effects models did not reveal statistically significant group differences in treatment by time interactions for HDRS-17 scores, and the estimated effect sizes between groups were as follows: double active vs tDCS only (Cohen d, 0.05; 95% CI, -0.48 to 0.58; P = .86), double active vs double sham (Cohen d, -0.20; 95% CI, -0.73 to 0.34; P = .47), and tDCS only vs double sham (Cohen d, -0.25; 95% CI, -0.76 to 0.27; P = .35). Skin redness and heat or burning sensations were more frequent in the double active and tDCS only groups. One nonfatal suicide attempt occurred in the tDCS only group. Conclusions and Relevance Unsupervised home-use tDCS combined with a digital psychological intervention or digital placebo was not found to be superior to sham for treatment of a major depressive episode in this trial. Trial Registration ClinicalTrials.gov Identifier: NCT04889976.
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Affiliation(s)
- Lucas Borrione
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Beatriz A. Cavendish
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Luana V. M. Aparicio
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Matthias S. Luethi
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
- Charlotte Fresenius Hochschule, Munich, Germany
| | - Matheus R. F. Ramos
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Natasha K. S. Moran
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Adriana M. Carneiro
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro Valiengo
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Darin O. Moura
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Juliana P. de Souza
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Mariana P. Batista
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Valquiria Aparecida da Silva
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Izio Klein
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo Suen
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - José Gallucci-Neto
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Lais B. Razza
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
- Ghent Experimental Psychiatry Laboratory, Ghent, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
- Ghent Experimental Psychiatry Laboratory, Ghent, Belgium
| | - Paulo A. Lotufo
- Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Isabela M. Bensenor
- Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics, and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Andre R. Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, Brazil
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Choi DS, Lee S. Optimizing electrode placement for transcranial direct current stimulation in nonsuperficial cortical regions: a computational modeling study. Biomed Eng Lett 2024; 14:255-265. [PMID: 38374912 PMCID: PMC10874366 DOI: 10.1007/s13534-023-00335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 02/21/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique for modulating neuronal excitability by sending a weak current through electrodes attached to the scalp. For decades, the conventional tDCS electrode for stimulating the superficial cortex has been widely reported. However, the investigation of the optimal electrode to effectively stimulate the nonsuperficial cortex is still lacking. In the current study, the optimal tDCS electrode montage that can deliver the maximum electric field to nonsuperficial cortical regions is investigated. Two finite element head models were used for computational simulation to determine the optimal montage for four different nonsuperficial regions: the left foot motor cortex, the left dorsomedial prefrontal cortex (dmPFC), the left medial orbitofrontal cortex (mOFC), and the primary visual cortex (V1). Our findings showed a good consistency in the optimal montage between two models, which led to the anode and cathode being attached to C4-C3 for the foot motor, F4-F3 for the dmPFC, Fp2-F7 for the mOFC, and Oz-Cz for V1. Our suggested montages are expected to enhance the overall effectiveness of stimulation of nonsuperficial cortical areas. Supplementary Information The online version contains supplementary material available at 10.1007/s13534-023-00335-2.
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Affiliation(s)
- Da Som Choi
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN USA
| | - Sangjun Lee
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN USA
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Jaiswal A, Goyal N, Shreekantiah U. High-Definition Transcranial Direct Current Stimulation-Primed Intermittent Theta Burst Stimulation in Treatment-Resistant Depression: A Controlled Study. J ECT 2024; 40:41-46. [PMID: 38411577 DOI: 10.1097/yct.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate whether high-definition transcranial direct current stimulation (HDtDCS) priming improves the efficacy of intermittent theta burst stimulation (iTBS) in improving TRD. METHODOLOGY A prospective hospital-based, randomized control study where the participants were divided into active or sham HDtDCS-primed iTBS stimulation groups for a total of 10 sessions and were assessed on clinical parameters at baseline, end of week 1, and end of week 2 was done. Primary outcome of the study was the difference in Hamilton Depression Rating Scale (HDRS) scores over 2 weeks of HDtDCS-primed iTBS. RESULT A significant effect of time was seen over HDRS scores in both active and sham groups with a large effect size. Significant effect of time was also found over the Clinical Global Impressions-Severity Scale scores of patients with a large effect size. The difference in the improvement in depressive severity as measured using HDRS and Clinical Global Impressions-Severity Scale scores between active and sham groups was also found to be significant with large effect sizes. CONCLUSION High-definition tDCS-primed iTBS is superior to normal iTBS in patients with depression who have failed a trial of 2 antidepressants, whereas both mechanisms are of benefit to the patients.
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Affiliation(s)
- Alankrit Jaiswal
- From the Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Nishant Goyal
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Yam P. Brain stimulation poised to move from last resort to frontline treatment. Proc Natl Acad Sci U S A 2024; 121:e2401731121. [PMID: 38330017 PMCID: PMC10873550 DOI: 10.1073/pnas.2401731121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
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Leaver AM, Chen YJ, Parrish TB. Focal tDCS of auditory cortex in chronic tinnitus: A randomized controlled mechanistic trial. Clin Neurophysiol 2024; 158:79-91. [PMID: 38198874 PMCID: PMC10896454 DOI: 10.1016/j.clinph.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/24/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The goal of this pilot study was to understand how focal transcranial direct current stimulation (tDCS) targeting auditory cortex changes brain function in chronic tinnitus using magnetic resonance imaging (MRI). METHODS People with chronic tinnitus were randomized to active or sham tDCS on five consecutive days in this mechanistic trial (n = 10/group). Focal 4x1 tDCS (central anode, surround cathodes) targeted left auditory cortex, with single-blind 2 mA current during twenty-minute sessions. Arterial spin-labeled and blood oxygenation level dependent MRI occurred immediately before and after the first tDCS session, and tinnitus symptoms were measured starting one week before the first tDCS session and through four weeks after the final session. RESULTS Acute increases in cerebral blood flow and functional connectivity were noted in auditory cortex after the first active tDCS session. Reduced tinnitus loudness ratings after the final tDCS session correlated with acute change in functional connectivity between an auditory network and mediodorsal thalamus and prefrontal cortex. Reduced tinnitus intrusiveness also correlated with acute change in connectivity between precuneus and an auditory network. CONCLUSIONS Focal auditory-cortex tDCS can influence function in thalamus, auditory, and prefrontal cortex, which may associate with improved tinnitus. SIGNIFICANCE With future refinement, tDCS targeting auditory cortex could become a viable intervention for tinnitus.
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Affiliation(s)
- Amber M Leaver
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA.
| | - Yufen J Chen
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
| | - Todd B Parrish
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
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Hsu CW, Chou PH, Brunoni AR, Hung KC, Tseng PT, Liang CS, Carvalho AF, Vieta E, Tu YK, Lin PY, Chu CS, Hsu TW, Chen YCB, Li CT. Comparing different non-invasive brain stimulation interventions for bipolar depression treatment: A network meta-analysis of randomized controlled trials. Neurosci Biobehav Rev 2024; 156:105483. [PMID: 38056187 DOI: 10.1016/j.neubiorev.2023.105483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/04/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
Non-invasive brain stimulation (NIBS) is a promising treatment for bipolar depression. We systematically searched for randomized controlled trials on NIBS for treating bipolar depression (INPLASY No: 202340019). Eighteen articles (N = 617) were eligible for network meta-analysis. Effect sizes were reported as standardized mean differences (SMDs) or odds ratios (ORs) with 95% confidence intervals (CIs). Anodal transcranial direct current stimulation over F3 plus cathodal transcranial direct current stimulation over F4 (a-tDCS-F3 +c-tDCS-F4; SMD = -1.18, 95%CIs = -1.66 to -0.69, N = 77), high-definition tDCS over F3 (HD-tDCS-F3; -1.17, -2.00 to -0.35, 25), high frequency deep transcranial magnetic stimulation (HF-dTMS; -0.81, -1.62 to -0.001, 25), and high frequency repetitive TMS over F3 plus low frequency repetitive TMS over F4 (HF-rTMS-F3 +LF-rTMS-F4; -0.77, -1.43 to -0.11, 38) significantly improved depressive symptoms compared to sham controls. Only a-tDCS-F3 +c-tDCS-F4 (OR = 4.53, 95%CIs = 1.51-13.65) and HF-rTMS-F3 +LF-rTMS-F4 (4.69, 1.02-21.56) showed higher response rates. No active NIBS interventions exhibited significant differences in dropout or side effect rates, compared with sham controls.
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Affiliation(s)
- Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Han Chou
- Dr. Chou's Mental Health Clinic; Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, National Institute of Biomarkers in Psychiatry, Laboratory of Neurosciences (LIM-27), Departamento e Instituto de Psiquiatria, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil; Departamento de Ciências Médicas, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ping-Tao Tseng
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan; Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Yu-Kang Tu
- Institute of Health Data Analytics & Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Che-Sheng Chu
- Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tien-Wei Hsu
- Department of Psychiatry, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan; Department of Psychiatry, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yang-Chieh Brian Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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11
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Kim J, Park S, Kim H, Roh D, Kim DH. Home-based, Remotely Supervised, 6-Week tDCS in Patients With Both MCI and Depression: A Randomized Double-Blind Placebo-Controlled Trial. Clin EEG Neurosci 2023:15500594231215847. [PMID: 38105601 DOI: 10.1177/15500594231215847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
As depressive symptom is considered a prodrome, a risk factor for progression from mild cognitive impairment (MCI) to dementia, improving depressive symptoms should be considered a clinical priority in patients with MCI undergoing transcranial direct current stimulation (tDCS) intervention. We aimed to comprehensively evaluate the efficacy of the home-based and remotely monitored tDCS in patients with both MCI and depression, by integrating cognitive, psychological, and electrophysiological indicators. In a 6-week, randomized, double blind, and sham-controlled study, 37 community-dwelling patients were randomly assigned to either an active or a sham stimulation group, and received 30 home-based sessions of 2 mA tDCS for 30 min with the anode located over the left and cathode over the right dorsolateral prefrontal cortex. We measured depressive symptoms, neurocognitive function, and resting-state electroencephalography. In terms of effects of both depressive symptoms and cognitive functions, active tDCS was not significantly different from sham tDCS. However, compared to sham stimulation, active tDCS decreased and increased the activation of delta and beta frequencies, respectively. Moreover, the increase in beta activity was correlated with the cognitive enhancement only in the active group. It was not possible to reach a definitive conclusion regarding the efficacy of tDCS on depression and cognition in patients with both MCI and depression. Nevertheless, the relationship between the changes of electrophysiology and cognitive performance suggests potential neuroplasticity enhancement implicated in cognitive processes by tDCS.
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Affiliation(s)
- Jiheon Kim
- Department of Psychiatry, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
- Mind-Neuromodulation Laboratory, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Seungchan Park
- Mind-Neuromodulation Laboratory, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Hansol Kim
- Mind-Neuromodulation Laboratory, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Daeyoung Roh
- Department of Psychiatry, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
- Mind-Neuromodulation Laboratory, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Do Hoon Kim
- Department of Psychiatry, Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
- Mind-Neuromodulation Laboratory, College of Medicine, Hallym University, Chuncheon, Republic of Korea
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12
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Rodrigues NO, Vidal Bravalhieri AA, de Moraes TP, Barros JA, Ansai JH, Christofoletti G. Efficacy of Transcranial Direct Current Stimulation (tDCS) on Cognition, Anxiety, and Mobility in Community-Dwelling Older Individuals: A Controlled Clinical Trial. Brain Sci 2023; 13:1614. [PMID: 38137062 PMCID: PMC10741841 DOI: 10.3390/brainsci13121614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) has gained popularity as a method of modulating cortical excitability in people with physical and mental disabilities. However, there is a lack of consensus on its effectiveness in older individuals. This study aimed to assess the efficacy of a 2-month tDCS program for improving physical and mental performance in community-dwelling older individuals. In this single-blinded, controlled clinical trial, forty-two participants were allocated to one of three groups: (1) the tDCS group, which received, twice a week, 20 min sessions of 2 mA electric current through electrodes placed on the dorsolateral prefrontal cortex; (2) the tDCS-placebo group, which underwent the same electrode placement as the tDCS group but without actual electric stimulation; and (3) the cognitive-control group, which completed crossword puzzles. Main outcome measures were cognition, mobility, and anxiety. Multivariate analyses of variance were employed. Significance was set at 5% (p < 0.05). Regarding the results, no significant benefits were observed in the tDCS group compared with the tDCS-placebo or cognitive-control groups for cognition (p = 0.557), mobility (p = 0.871), or anxiety (p = 0.356). Cognition exhibited positive oscillations during the assessments (main effect of time: p = 0.001). However, given that all groups showed similar variations in cognitive scores (main effect of group: p = 0.101; group × time effect: p = 0.557), it is more likely that the improvement reflects the learning response of the participants to the cognitive tests rather than the effect of tDCS. In conclusion, a 2-month tDCS program with two sessions per week appears to be ineffective in improving physical and mental performance in community-dwelling older individuals. Further studies are necessary to establish whether or not tDCS is effective in healthy older individuals.
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Affiliation(s)
- Nathalia Oliveira Rodrigues
- Institute of Health, Faculty of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79060-900, Brazil; (N.O.R.); (A.A.V.B.); (T.P.d.M.)
| | - Anna Alice Vidal Bravalhieri
- Institute of Health, Faculty of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79060-900, Brazil; (N.O.R.); (A.A.V.B.); (T.P.d.M.)
| | - Tatiane Pereira de Moraes
- Institute of Health, Faculty of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79060-900, Brazil; (N.O.R.); (A.A.V.B.); (T.P.d.M.)
| | - Jorge Aparecido Barros
- Department of Physical Therapy, Dom Bosco Catholic University (UCDB), Campo Grande 79117-900, Brazil;
| | - Juliana Hotta Ansai
- Department of Gerontology, Federal University of São Carlos (UFSCAR), São Carlos 13565-905, Brazil;
| | - Gustavo Christofoletti
- Institute of Health, Faculty of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande 79060-900, Brazil; (N.O.R.); (A.A.V.B.); (T.P.d.M.)
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13
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Aberra AS, Wang R, Grill WM, Peterchev AV. Multi-scale model of axonal and dendritic polarization by transcranial direct current stimulation in realistic head geometry. Brain Stimul 2023; 16:1776-1791. [PMID: 38056825 PMCID: PMC10842743 DOI: 10.1016/j.brs.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation modality that can alter cortical excitability. However, it remains unclear how the subcellular elements of different neuron types are polarized by specific electric field (E-field) distributions. OBJECTIVE To quantify neuronal polarization generated by tDCS in a multi-scale computational model. METHODS We embedded layer-specific, morphologically-realistic cortical neuron models in a finite element model of the E-field in a human head and simulated steady-state polarization generated by conventional primary-motor-cortex-supraorbital (M1-SO) and 4 × 1 high-definition (HD) tDCS. We quantified somatic, axonal, and dendritic polarization of excitatory pyramidal cells in layers 2/3, 5, and 6, as well as inhibitory interneurons in layers 1 and 4 of the hand knob. RESULTS Axonal and dendritic terminals were polarized more than the soma in all neurons, with peak axonal and dendritic polarization of 0.92 mV and 0.21 mV, respectively, compared to peak somatic polarization of 0.07 mV for 1.8 mA M1-SO stimulation. Both montages generated regions of depolarization and hyperpolarization beneath the M1 anode; M1-SO produced slightly stronger, more diffuse polarization peaking in the central sulcus, while 4 × 1 HD produced higher peak polarization in the gyral crown. The E-field component normal to the cortical surface correlated strongly with pyramidal neuron somatic polarization (R2>0.9), but exhibited weaker correlations with peak pyramidal axonal and dendritic polarization (R2:0.5-0.9) and peak polarization in all subcellular regions of interneurons (R2:0.3-0.6). Simulating polarization by uniform local E-field extracted at the soma approximated the spatial distribution of tDCS polarization but produced large errors in some regions (median absolute percent error: 7.9 %). CONCLUSIONS Polarization of pre- and postsynaptic compartments of excitatory and inhibitory cortical neurons may play a significant role in tDCS neuromodulation. These effects cannot be predicted from the E-field distribution alone but rather require calculation of the neuronal response.
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Affiliation(s)
- Aman S Aberra
- Dept. of Biomedical Engineering, Pratt School of Engineering, Duke University, NC, USA.
| | - Ruochen Wang
- Dept. of Biomedical Engineering, Pratt School of Engineering, Duke University, NC, USA; Dept. of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, NC, USA.
| | - Warren M Grill
- Dept. of Biomedical Engineering, Pratt School of Engineering, Duke University, NC, USA; Dept. of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, NC, USA; Dept. of Neurobiology, School of Medicine, Duke University, NC, USA; Dept. of Neurosurgery, School of Medicine, Duke University, NC, USA.
| | - Angel V Peterchev
- Dept. of Biomedical Engineering, Pratt School of Engineering, Duke University, NC, USA; Dept. of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, NC, USA; Dept. of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, NC, USA; Dept. of Neurosurgery, School of Medicine, Duke University, NC, USA.
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14
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Kumpf U, Palm U, Eder J, Ezim H, Stadler M, Burkhardt G, Dechantsreiter E, Padberg F. TDCS at home for depressive disorders: an updated systematic review and lessons learned from a prematurely terminated randomized controlled pilot study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1403-1420. [PMID: 37191697 PMCID: PMC10185954 DOI: 10.1007/s00406-023-01620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
The application of transcranial direct current stimulation (tDCS) at home for the treatment of major depressive disorder (MDD) is the subject of current clinical trials. This is due to its positive safety profile, cost-effectiveness, and potential scalability for a wide outreach in clinical practice. Here, we provide a systematic review of the available studies and also a report on the results of a randomized controlled trial (RCT) on tDCS at home for the treatment of MDD. This trial had to be prematurely terminated due to safety concerns. The HomeDC trial is a double-blinded, placebo-controlled, parallel-group study. Patients with MDD (DSM-5) were randomized to active or sham tDCS. Patients conducted tDCS at home for 6 weeks with 5 sessions/week (30 min at 2 mA) anode over F3, cathode over F4. Sham tDCS resembled active tDCS, with ramp-in and ramp-out periods, but without intermittent stimulation. The study was prematurely terminated due to an accumulation of adverse events (AEs, skin lesions), so that only 11 patients were included. Feasibility was good. Safety monitoring was not sufficient enough to detect or prevent AEs within an appropriate timeframe. Regarding antidepressant effects, the reduction in depression scales over time was significant. However, active tDCS was not superior to sham tDCS in this regard. Both the conclusions from this review and the HomeDC trial show that there are several critical issues with the use of tDCS at home that need to be addressed. Nevertheless the array of transcranial electric simulation (TES) methods that this mode of application offers, including tDCS, is highly interesting and warrants further investigation in high quality RCTs. TRIAL REGISTRATION www. CLINICALTRIALS gov . TRIAL REGISTRATION NUMBER NCT05172505. Registration date: 12/13/2021, https://clinicaltrials.gov/ct2/show/NCT05172505 . *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers) **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71 . For more information, visit: http://www.prisma-statement.org/.
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Affiliation(s)
- Ulrike Kumpf
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - Ulrich Palm
- Medicalpark Chiemseeblick, Bernau-Felden, Germany
| | - Julia Eder
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Harry Ezim
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Matthias Stadler
- Faculty of Psychology and Educational Sciences Ludwig Maximilian University Munich, Munich, Germany
| | - Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Esther Dechantsreiter
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Nussbaumstr. 7, 80336, Munich, Germany
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Shkundin A, Halaris A. Associations of BDNF/BDNF-AS SNPs with Depression, Schizophrenia, and Bipolar Disorder. J Pers Med 2023; 13:1395. [PMID: 37763162 PMCID: PMC10533016 DOI: 10.3390/jpm13091395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Brain-Derived Neurotrophic Factor (BDNF) is crucial for various aspects of neuronal development and function, including synaptic plasticity, neurotransmitter release, and supporting neuronal differentiation, growth, and survival. It is involved in the formation and preservation of dopaminergic, serotonergic, GABAergic, and cholinergic neurons, facilitating efficient stimulus transmission within the synaptic system and contributing to learning, memory, and overall cognition. Furthermore, BDNF demonstrates involvement in neuroinflammation and showcases neuroprotective effects. In contrast, BDNF antisense RNA (BDNF-AS) is linked to the regulation and control of BDNF, facilitating its suppression and contributing to neurotoxicity, apoptosis, and decreased cell viability. This review article aims to comprehensively overview the significance of single nucleotide polymorphisms (SNPs) in BDNF/BDNF-AS genes within psychiatric conditions, with a specific focus on their associations with depression, schizophrenia, and bipolar disorder. The independent influence of each BDNF/BDNF-AS gene variation, as well as the interplay between SNPs and their linkage disequilibrium, environmental factors, including early-life experiences, and interactions with other genes, lead to alterations in brain architecture and function, shaping vulnerability to mental health disorders. The potential translational applications of BDNF/BDNF-AS polymorphism knowledge can revolutionize personalized medicine, predict disease susceptibility, treatment outcomes, and guide the selection of interventions tailored to individual patients.
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Affiliation(s)
| | - Angelos Halaris
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA
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16
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Cho JY, Van Hoornweder S, Sege CT, Antonucci MU, McTeague LM, Caulfield KA. Template MRI scans reliably approximate individual and group-level tES and TMS electric fields induced in motor and prefrontal circuits. Front Neural Circuits 2023; 17:1214959. [PMID: 37736398 PMCID: PMC10510202 DOI: 10.3389/fncir.2023.1214959] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/09/2023] [Indexed: 09/23/2023] Open
Abstract
Background Electric field (E-field) modeling is a valuable method of elucidating the cortical target engagement from transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES), but it is typically dependent on individual MRI scans. In this study, we systematically tested whether E-field models in template MNI-152 and Ernie scans can reliably approximate group-level E-fields induced in N = 195 individuals across 5 diagnoses (healthy, alcohol use disorder, tobacco use disorder, anxiety, depression). Methods We computed 788 E-field models using the CHARM-SimNIBS 4.0.0 pipeline with 4 E-field models per participant (motor and prefrontal targets for TMS and tES). We additionally calculated permutation analyses to determine the point of stability of E-fields to assess whether the 152 brains represented in the MNI-152 template is sufficient. Results Group-level E-fields did not significantly differ between the individual vs. MNI-152 template and Ernie scans for any stimulation modality or location (p > 0.05). However, TMS-induced E-field magnitudes significantly varied by diagnosis; individuals with generalized anxiety had significantly higher prefrontal and motor E-field magnitudes than healthy controls and those with alcohol use disorder and depression (p < 0.001). The point of stability for group-level E-field magnitudes ranged from 42 (motor tES) to 52 participants (prefrontal TMS). Conclusion MNI-152 and Ernie models reliably estimate group-average TMS and tES-induced E-fields transdiagnostically. The MNI-152 template includes sufficient scans to control for interindividual anatomical differences (i.e., above the point of stability). Taken together, using the MNI-152 and Ernie brains to approximate group-level E-fields is a valid and reliable approach.
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Affiliation(s)
- Jennifer Y. Cho
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
| | - Sybren Van Hoornweder
- Faculty of Rehabilitation Sciences, REVAL–Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Christopher T. Sege
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Michael U. Antonucci
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Lisa M. McTeague
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - Kevin A. Caulfield
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
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17
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Aberra AS, Wang R, Grill WM, Peterchev AV. Multi-scale model of axonal and dendritic polarization by transcranial direct current stimulation in realistic head geometry. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.23.554447. [PMID: 37767087 PMCID: PMC10522328 DOI: 10.1101/2023.08.23.554447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Background Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation modality that can alter cortical excitability. However, it remains unclear how the subcellular elements of different neuron types are polarized by specific electric field (E-field) distributions. Objective To quantify neuronal polarization generated by tDCS in a multi-scale computational model. Methods We embedded layer-specific, morphologically-realistic cortical neuron models in a finite element model of the E-field in a human head and simulated steady-state polarization generated by conventional primary-motor-cortex-supraorbital (M1-SO) and 4×1 high-definition (HD) tDCS. We quantified somatic, axonal, and dendritic polarization of excitatory pyramidal cells in layers 2/3, 5, and 6, as well as inhibitory interneurons in layers 1 and 4 of the hand knob. Results Axonal and dendritic terminals were polarized more than the soma in all neurons, with peak axonal and dendritic polarization of 0.92 mV and 0.21 mV, respectively, compared to peak somatic polarization of 0.07 mV for 1.8 mA M1-SO stimulation. Both montages generated regions of depolarization and hyperpolarization beneath the M1 anode; M1-SO produced slightly stronger, more diffuse polarization peaking in the central sulcus, while 4×1 HD produced higher peak polarization in the gyral crown. Simulating polarization by uniform local E-field approximated the spatial distribution of tDCS polarization but produced large errors in some regions. Conclusions Polarization of pre- and postsynaptic compartments of excitatory and inhibitory cortical neurons may play a significant role in tDCS neuromodulation. These effects cannot be predicted from the E-field distribution alone but rather require calculation of the neuronal response.
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Burkhardt G, Kumpf U, Crispin A, Goerigk S, Andre E, Plewnia C, Brendel B, Fallgatter A, Langguth B, Abdelnaim M, Hebel T, Normann C, Frase L, Zwanzger P, Diemer J, Kammer T, Schönfeldt-Lecuona C, Kamp D, Bajbouj M, Behler N, Wilkening A, Nenov-Matt T, Dechantsreiter E, Keeser D, Bulubas L, Palm U, Blankenstein C, Mansmann U, Falkai P, Brunoni AR, Hasan A, Padberg F. Transcranial direct current stimulation as an additional treatment to selective serotonin reuptake inhibitors in adults with major depressive disorder in Germany (DepressionDC): a triple-blind, randomised, sham-controlled, multicentre trial. Lancet 2023; 402:545-554. [PMID: 37414064 DOI: 10.1016/s0140-6736(23)00640-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/28/2023] [Accepted: 03/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) has been proposed as a feasible treatment for major depressive disorder (MDD). However, meta-analytic evidence is heterogenous and data from multicentre trials are scarce. We aimed to assess the efficacy of tDCS versus sham stimulation as an additional treatment to a stable dose of selective serotonin reuptake inhibitors (SSRIs) in adults with MDD. METHODS The DepressionDC trial was triple-blind, randomised, and sham-controlled and conducted at eight hospitals in Germany. Patients being treated at a participating hospital aged 18-65 years were eligible if they had a diagnosis of MDD, a score of at least 15 on the Hamilton Depression Rating Scale (21-item version), no response to at least one antidepressant trial in their current depressive episode, and treatment with an SSRI at a stable dose for at least 4 weeks before inclusion; the SSRI was continued at the same dose during stimulation. Patients were allocated (1:1) by fixed-blocked randomisation to receive either 30 min of 2 mA bifrontal tDCS every weekday for 4 weeks, then two tDCS sessions per week for 2 weeks, or sham stimulation at the same intervals. Randomisation was stratified by site and baseline Montgomery-Åsberg Depression Rating Scale (MADRS) score (ie, <31 or ≥31). Participants, raters, and operators were masked to treatment assignment. The primary outcome was change on the MADRS at week 6, analysed in the intention-to-treat population. Safety was assessed in all patients who received at least one treatment session. The trial was registered with ClinicalTrials.gov (NCT02530164). FINDINGS Between Jan 19, 2016, and June 15, 2020, 3601 individuals were assessed for eligibility. 160 patients were included and randomly assigned to receive either active tDCS (n=83) or sham tDCS (n=77). Six patients withdrew consent and four patients were found to have been wrongly included, so data from 150 patients were analysed (89 [59%] were female and 61 [41%] were male). No intergroup difference was found in mean improvement on the MADRS at week 6 between the active tDCS group (n=77; -8·2, SD 7·2) and the sham tDCS group (n=73; -8·0, 9·3; difference 0·3 [95% CI -2·4 to 2·9]). Significantly more participants had one or more mild adverse events in the active tDCS group (50 [60%] of 83) than in the sham tDCS group (33 [43%] of 77; p=0·028). INTERPRETATION Active tDCS was not superior to sham stimulation during a 6-week period. Our trial does not support the efficacy of tDCS as an additional treatment to SSRIs in adults with MDD. FUNDING German Federal Ministry of Education and Research.
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Affiliation(s)
- Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ulrike Kumpf
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexander Crispin
- Ludwig-Maximilians-Universität Hospital, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stephan Goerigk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Psychological Methodology and Assessment, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Psychology, Charlotte Fresenius Hochschule, University of Psychology, Munich, Germany
| | - Elisabeth Andre
- Münchner Studienzentrum, Technical University of Munich, Munich, Germany
| | - Christian Plewnia
- Tübingen Center for Mental Health, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Bettina Brendel
- Tübingen Center for Mental Health, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany; Institute of Clinical Epidemiology and Applied Biostatistics, University of Tübingen, Tübingen, Germany
| | - Andreas Fallgatter
- Tübingen Center for Mental Health, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Mohamed Abdelnaim
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Tobias Hebel
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine and Center for Basics in Neuromodulation, University of Freiburg, Freiburg, Germany
| | - Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany; kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Wasserburg am Inn, Germany
| | - Julia Diemer
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany; kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Wasserburg am Inn, Germany
| | - Thomas Kammer
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | | | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Landschaftsverband-Rheinland-Klinikum Düsseldorf, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité-Campus Benjamin Franklin, University Medicine Berlin, Berlin, Germany
| | - Nora Behler
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anja Wilkening
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tabea Nenov-Matt
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Esther Dechantsreiter
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany; NeuroImaging Core Unit Munich, Ludwig-Maximilians-Universität München, Munich, Germany; Munich Center for Neurosciences-Brain and Mind, Munich, Germany
| | - Lucia Bulubas
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany; Medical Park Chiemseeblick, Bernau, Germany
| | | | - Ulrich Mansmann
- Ludwig-Maximilians-Universität Hospital, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany; Munich Center for Neurosciences-Brain and Mind, Munich, Germany
| | - Andre R Brunoni
- Department of Internal Medicine and Department of Psychiatry, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany.
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Voineskos D, Blumberger DM. Transcranial direct current stimulation as a treatment for major depressive disorder. Lancet 2023; 402:506-507. [PMID: 37414063 DOI: 10.1016/s0140-6736(23)00822-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Leaver AM, Chen YJ, Parrish TB. Focal transcranial direct current stimulation of auditory cortex in chronic tinnitus: A randomized controlled mechanistic trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.12.23292557. [PMID: 37502874 PMCID: PMC10370232 DOI: 10.1101/2023.07.12.23292557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objective The goal of this pilot MRI study was to understand how focal transcranial direct current stimulation (tDCS) targeting auditory cortex changes brain function in chronic tinnitus. Methods People with chronic tinnitus were randomized to active or sham tDCS on five consecutive days in this pilot mechanistic trial (n=10/group). Focal 4×1 tDCS (central anode, surround cathodes) targeted left auditory cortex, with single-blind 2mA current during twenty-minute sessions. Arterial spin-labeled and blood oxygenation level dependent MRI occurred immediately before and after the first tDCS session, and tinnitus symptoms were measured starting one week before the first tDCS session and through four weeks after the final session. Results Acute increases in cerebral blood flow and functional connectivity were noted in auditory cortex after the first active tDCS session. Reduced tinnitus loudness ratings after the final tDCS session correlated with acute change in functional connectivity between an auditory network and mediodorsal thalamus and prefrontal cortex. Reduced tinnitus intrusiveness also correlated with acute change in connectivity between precuneus and an auditory network. Conclusions Focal auditory-cortex tDCS can influence function in thalamus, auditory, and prefrontal cortex, which may associate with improved tinnitus. Significance With future refinement, noninvasive brain stimulation targeting auditory cortex could become a viable intervention for tinnitus.
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Affiliation(s)
- Amber M. Leaver
- Department of Radiology, Northwestern University, Chicago, IL, 60611
| | - Yufen J. Chen
- Department of Radiology, Northwestern University, Chicago, IL, 60611
| | - Todd B. Parrish
- Department of Radiology, Northwestern University, Chicago, IL, 60611
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21
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Kumari B, Singh A, Kar SK, Tripathi A, Agarwal V. Bifrontal-transcranial direct current stimulation as an early augmentation strategy in major depressive disorder: A single-blind randomised controlled trial. Asian J Psychiatr 2023; 86:103637. [PMID: 37270874 DOI: 10.1016/j.ajp.2023.103637] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/21/2023] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Patients with major depressive disorder who have a poor or inconsistent response to antidepressants have been treated using transcranial direct current stimulation (tDCS). Early tDCS augmentation may help with the early amelioration of symptoms. In this study, the efficacy and safety of tDCS as early augmentation therapy in major depressive disorder were evaluated. METHODS Fifty adults were randomized into two groups and were administered either active tDCS or sham tDCS, along with escitalopram 10 mg/day. A total of 10 tDCS sessions with anodal stimulation at the left dorsolateral prefrontal cortex (DLPFC) and cathode at the right DLPFC were given over two weeks. Assessments were done using Hamilton Depression Rating Scale (HAM-D), Beck's Depression Inventory (BDI), and Hamilton Anxiety Rating Scale (HAM-A) at baseline, two weeks, and four weeks. A tDCS side effect checklist was administered during therapy. RESULTS A significant reduction in HAM-D, BDI, and HAM-A scores were observed in both groups from baseline to week-4. At week-2, the active group had a significantly greater reduction in HAM-D and BDI scores than the sham group. However, at the end of therapy, both groups were comparable. The active group was 1.12 times more likely to experience any side effect than the sham group, but the intensity ranged from mild to moderate. CONCLUSION tDCS is an effective and safe strategy for managing depression as an early augmentation strategy, and it produces an early reduction of depressive symptoms and is well tolerated in moderate to severe depressive episodes.
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Affiliation(s)
- Babli Kumari
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India.
| | - Amit Singh
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India.
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India.
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India.
| | - Vivek Agarwal
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India.
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22
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Casula A, Milazzo BM, Martino G, Sergi A, Lucifora C, Tomaiuolo F, Quartarone A, Nitsche MA, Vicario CM. Non-Invasive Brain Stimulation for the Modulation of Aggressive Behavior-A Systematic Review of Randomized Sham-Controlled Studies. Life (Basel) 2023; 13:life13051220. [PMID: 37240865 DOI: 10.3390/life13051220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
INTRO Aggressive behavior represents a significant public health issue, with relevant social, political, and security implications. Non-invasive brain stimulation (NIBS) techniques may modulate aggressive behavior through stimulation of the prefrontal cortex. AIMS To review research on the effectiveness of NIBS to alter aggression, discuss the main findings and potential limitations, consider the specifics of the techniques and protocols employed, and discuss clinical implications. METHODS A systematic review of the literature available in the PubMed database was carried out, and 17 randomized sham-controlled studies investigating the effectiveness of NIBS techniques on aggression were included. Exclusion criteria included reviews, meta-analyses, and articles not referring to the subject of interest or not addressing cognitive and emotional modulation aims. CONCLUSIONS The reviewed data provide promising evidence for the beneficial effects of tDCS, conventional rTMS, and cTBS on aggression in healthy adults, forensic, and clinical samples. The specific stimulation target is a key factor for the success of stimulation on aggression modulation. rTMS and cTBS showed opposite effects on aggression compared with tDCS. However, due to the heterogeneity of stimulation protocols, experimental designs, and samples, we cannot exclude other factors that may play a confounding role.
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Affiliation(s)
- Antony Casula
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, 98121 Messina, Italy
| | - Bianca M Milazzo
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, 98121 Messina, Italy
| | - Gabriella Martino
- Dipartimento di Medicina e Clinica Sperimentale, Università degli Studi di Messina, A.O.U. "G. Martino", Via Consolare Valeria, 98125 Messina, Italy
| | - Alessandro Sergi
- Dipartimento di Scienze Matematiche e Informatiche, Scienze Fisiche e Scienze della Terra, Università degli Studi di Messina, Viale F. Stagno d'Alcontres 31, 98166 Messina, Italy
| | - Chiara Lucifora
- Dipartimento di Filosofia e Comunicazione, Università di Bologna, 40131 Bologna, Italy
| | - Francesco Tomaiuolo
- Dipartimento di Medicina e Clinica Sperimentale, Università degli Studi di Messina, A.O.U. "G. Martino", Via Consolare Valeria, 98125 Messina, Italy
| | | | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, 44139 Dortmund, Germany
- University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital of Bethel Foundation, University Hospital OWL, Bielefeld University, 33615 Bielefeld, Germany
| | - Carmelo M Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, 98121 Messina, Italy
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Abstract
Bipolar disorders (BDs) are recurrent and sometimes chronic disorders of mood that affect around 2% of the world's population and encompass a spectrum between severe elevated and excitable mood states (mania) to the dysphoria, low energy, and despondency of depressive episodes. The illness commonly starts in young adults and is a leading cause of disability and premature mortality. The clinical manifestations of bipolar disorder can be markedly varied between and within individuals across their lifespan. Early diagnosis is challenging and misdiagnoses are frequent, potentially resulting in missed early intervention and increasing the risk of iatrogenic harm. Over 15 approved treatments exist for the various phases of bipolar disorder, but outcomes are often suboptimal owing to insufficient efficacy, side effects, or lack of availability. Lithium, the first approved treatment for bipolar disorder, continues to be the most effective drug overall, although full remission is only seen in a subset of patients. Newer atypical antipsychotics are increasingly being found to be effective in the treatment of bipolar depression; however, their long term tolerability and safety are uncertain. For many with bipolar disorder, combination therapy and adjunctive psychotherapy might be necessary to treat symptoms across different phases of illness. Several classes of medications exist for treating bipolar disorder but predicting which medication is likely to be most effective or tolerable is not yet possible. As pathophysiological insights into the causes of bipolar disorders are revealed, a new era of targeted treatments aimed at causal mechanisms, be they pharmacological or psychosocial, will hopefully be developed. For the time being, however, clinical judgment, shared decision making, and empirical follow-up remain essential elements of clinical care. This review provides an overview of the clinical features, diagnostic subtypes, and major treatment modalities available to treat people with bipolar disorder, highlighting recent advances and ongoing therapeutic challenges.
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Affiliation(s)
- Fernando S Goes
- Precision Medicine Center of Excellence in Mood Disorders, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Pedraz-Petrozzi B, Sardinha H, Gilles M, Deuschle M. Effects of left anodal transcranial direct current stimulation on hypothalamic-pituitary-adrenal axis activity in depression: a randomized controlled pilot trial. Sci Rep 2023; 13:5619. [PMID: 37024593 PMCID: PMC10079657 DOI: 10.1038/s41598-023-32531-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
The main objective of this study was to evaluate the effect of left anodal transcranial direct current stimulation (tDCS) on hypothalamic-pituitary-adrenal axis (HPAA) activity in individuals with depression. We conducted a 3-week, randomized, triple-blind pilot trial with 47 participants (dropout rate: 14.89%) randomly assigned to either the tDCS or control group (sham stimulation). Salivary cortisol was used as an HPAA activity marker since cortisol is the effector hormone of the HPAA. The primary outcome was the effect of tDCS on the diurnal cortisol pattern (DCP and area under the curve with respect to ground -AUCg-). Secondary outcomes included tDCS effects on cortisol awakening response (CAR) and cortisol decline (CD), as well as the variation of cortisol concentrations between the initiation of tDCS and 2 weeks later. Intention-to-treat and per-protocol analyses were conducted. Our primary outcome showed an absent effect of tDCS on DCP and AUCg. Additionally, tDCS had an absent effect on CAR, CD, and cortisol concentration variation before-after stimulation. Our pilot study suggests that anodal tDCS showed an absent effect on HPAA activity in individuals with depression. More studies are needed to confirm these findings.
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Affiliation(s)
- Bruno Pedraz-Petrozzi
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany.
| | - Helena Sardinha
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany
| | - Maria Gilles
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, RG Stress, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J5, 68159, Mannheim, Germany
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Nikolin S, Moffa A, Razza L, Martin D, Brunoni A, Palm U, Padberg F, Bennabi D, Haffen E, Blumberger DM, Salehinejad MA, Loo CK. Time-course of the tDCS antidepressant effect: An individual participant data meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110752. [PMID: 36931456 DOI: 10.1016/j.pnpbp.2023.110752] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Prefrontal transcranial direct current stimulation (tDCS) shows promise as an effective treatment for depression. However, factors influencing treatment and the time-course of symptom improvements remain to be elucidated. METHODS Individual participant data was collected from ten randomised controlled trials of tDCS in depression. Depressive symptom scores were converted to a common scale, and a linear mixed effects individual growth curve model was fit to the data using k-fold cross-validation to prevent overfitting. RESULTS Data from 576 participants were analysed (tDCS: n = 311; sham: n = 265), of which 468 were unipolar and 108 had bipolar disorder. tDCS effect sizes reached a peak at approximately 6 weeks, and continued to diverge from sham up to 10 weeks. Significant predictors associated with worse response included higher baseline depression severity, treatment resistance, and those associated with better response included bipolar disorder and anxiety disorder. CONCLUSIONS Our findings suggest that longer treatment courses, lasting at least 6 weeks in duration, may be indicated. Further, our results show that tDCS is effective for depressive symptoms in bipolar disorder. Compared to unipolar depression, participants with bipolar disorder may require additional maintenance sessions to prevent rapid relapse.
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Affiliation(s)
- Stevan Nikolin
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia.
| | - Adriano Moffa
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Lais Razza
- Serviço Interdisciplinar de Neuromodulação (SIN), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Donel Martin
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Andre Brunoni
- Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Brazil
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Medical Park Chiemseeblick, Bernau-Felden, Germany
| | - Djamila Bennabi
- Centre d'Investigation Clinique, CIC-INSERM-1431, Centre Hospitalier Universitaire de Besançon CHU, Besançon, France
| | - Emmanuel Haffen
- Centre d'Investigation Clinique, CIC-INSERM-1431, Centre Hospitalier Universitaire de Besançon CHU, Besançon, France
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
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D'Urso G, Toscano E, Barone A, Palermo M, Dell'Osso B, Di Lorenzo G, Mantovani A, Martinotti G, Fornaro M, Iasevoli F, de Bartolomeis A. Transcranial direct current stimulation for bipolar depression: systematic reviews of clinical evidence and biological underpinnings. Prog Neuropsychopharmacol Biol Psychiatry 2023; 121:110672. [PMID: 36332699 DOI: 10.1016/j.pnpbp.2022.110672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/09/2022] [Accepted: 10/26/2022] [Indexed: 11/08/2022]
Abstract
Despite multiple available treatments for bipolar depression (BD), many patients face sub-optimal responses. Transcranial direct current stimulation (tDCS) has been advocated in the management of different conditions, including BD, especially in treatment-resistant cases. The optimal dose and timing of tDCS, the mutual influence with other concurrently administered interventions, long-term efficacy, overall safety, and biological underpinnings nonetheless deserve additional assessment. The present study appraised the existing clinical evidence about tDCS for bipolar depression, delving into the putative biological underpinnings with a special emphasis on cellular and molecular levels, with the ultimate goal of providing a translational perspective on the matter. Two separate systematic reviews across the PubMed database since inception up to August 8th 2022 were performed, with fourteen clinical and nineteen neurobiological eligible studies. The included clinical studies encompass 207 bipolar depression patients overall and consistently document the efficacy of tDCS, with a reduction in depression scores after treatment ranging from 18% to 92%. The RCT with the largest sample clearly showed a significant superiority of active stimulation over sham. Mild-to-moderate and transient adverse effects are attributed to tDCS across these studies. The review of neurobiological literature indicates that several molecular mechanisms may account for the antidepressant effect of tDCS in BD patients, including the action on calcium homeostasis in glial cells, the enhancement of LTP, the regulation of neurotrophic factors and inflammatory mediators, and the modulation of the expression of plasticity-related genes. To the best of our knowledge, this is the first study on the matter to concurrently provide a synthesis of the clinical evidence and an in-depth appraisal of the putative biological underpinnings, providing consistent support for the efficacy, safety, and tolerability of tDCS.
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Affiliation(s)
- Giordano D'Urso
- Section of Psychiatry, Clinical Unit of Psychiatry and Psychology, Unit of Treatment Resistance in Psychiatry, Laboratory of Neuromodulation, Laboratory of Molecular and Translational Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Clinical Department of Head and Neck, University of Naples Federico II, Napoli, Italy.
| | - Elena Toscano
- Section of Psychiatry, Clinical Unit of Psychiatry and Psychology, Unit of Treatment Resistance in Psychiatry, Laboratory of Neuromodulation, Laboratory of Molecular and Translational Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Clinical Department of Head and Neck, University of Naples Federico II, Napoli, Italy
| | - Annarita Barone
- Section of Psychiatry, Clinical Unit of Psychiatry and Psychology, Unit of Treatment Resistance in Psychiatry, Laboratory of Neuromodulation, Laboratory of Molecular and Translational Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Clinical Department of Head and Neck, University of Naples Federico II, Napoli, Italy
| | - Mario Palermo
- Section of Psychiatry, Clinical Unit of Psychiatry and Psychology, Unit of Treatment Resistance in Psychiatry, Laboratory of Neuromodulation, Laboratory of Molecular and Translational Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Clinical Department of Head and Neck, University of Naples Federico II, Napoli, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences Luigi Sacco, Ospedale Luigi Sacco Polo Universitario, ASST Fatebenefratelli Sacco, Milan, Italy; Department of Psychiatry and Behavioural Sciences, Bipolar Disorders Clinic, Stanford University, CA, USA; CRC "Aldo Ravelli" for Neuro-technology & Experimental Brain Therapeutics, University of Milan, Italy
| | - Giorgio Di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, Tor Vergata University of Rome, Italy; Psychiatric and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Antonio Mantovani
- Dipartimento di Medicina e Scienze della Salute "V. Tiberio" Università degli Studi del Molise, Campobasso, Italy; Dipartimento di Salute Mentale e delle Dipendenze, Azienda Sanitaria Regionale del Molise (ASReM), Campobasso, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University Gabriele d'Annunzio, Chieti-Pescara, Italy; Department of Pharmacy, Pharmacology, Clinical Sciences, University of Hertfordshire, Herts, UK
| | - Michele Fornaro
- Section of Psychiatry, Clinical Unit of Psychiatry and Psychology, Unit of Treatment Resistance in Psychiatry, Laboratory of Neuromodulation, Laboratory of Molecular and Translational Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Clinical Department of Head and Neck, University of Naples Federico II, Napoli, Italy
| | - Felice Iasevoli
- Section of Psychiatry, Clinical Unit of Psychiatry and Psychology, Unit of Treatment Resistance in Psychiatry, Laboratory of Neuromodulation, Laboratory of Molecular and Translational Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Clinical Department of Head and Neck, University of Naples Federico II, Napoli, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry, Clinical Unit of Psychiatry and Psychology, Unit of Treatment Resistance in Psychiatry, Laboratory of Neuromodulation, Laboratory of Molecular and Translational Psychiatry, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Clinical Department of Head and Neck, University of Naples Federico II, Napoli, Italy
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27
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Transcranial direct current stimulation (tDCS) in depression induces structural plasticity. Sci Rep 2023; 13:2841. [PMID: 36801903 PMCID: PMC9938111 DOI: 10.1038/s41598-023-29792-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/10/2023] [Indexed: 02/19/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique involving administration of well-tolerated electrical current to the brain through scalp electrodes. TDCS may improve symptoms in neuropsychiatric disorders, but mixed results from recent clinical trials underscore the need to demonstrate that tDCS can modulate clinically relevant brain systems over time in patients. Here, we analyzed longitudinal structural MRI data from a randomized, double-blind, parallel-design clinical trial in depression (NCT03556124, N = 59) to investigate whether serial tDCS individually targeted to the left dorso-lateral prefrontal cortex (DLPFC) can induce neurostructural changes. Significant (FWEc p < 0.05) treatment-related gray matter changes were observed with active high-definition (HD) tDCS relative to sham tDCS within the left DLPFC stimulation target. No changes were observed with active conventional tDCS. A follow-up analysis within individual treatment groups revealed significant gray matter increases with active HD-tDCS in brain regions functionally connected with the stimulation target, including the bilateral DLPFC, bilateral posterior cingulate cortex, subgenual anterior cingulate cortex, and the right hippocampus, thalamus and left caudate brain regions. Integrity of blinding was verified, no significant differences in stimulation-related discomfort were observed between treatment groups, and tDCS treatments were not augmented by any other adjunct treatments. Overall, these results demonstrate that serial HD-tDCS leads to neurostructural changes at a predetermined brain target in depression and suggest that such plasticity effects may propagate over brain networks.
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Abstract
AIMS Bipolar disorders are clinically complex, chronic and recurrent disorders. Few treatment options are effective across hypomanic, manic, depressive and mixed states and as continuation or maintenance treatment after initial symptom remission. The aim of this review was to provide an up-to-date overview of research on the efficacy, tolerability and cognitive effects of electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), magnetic seizure therapy (MST), deep brain stimulation (DBS) and vagus nerve stimulation (VNS). METHODS References included in this review were identified through multiple searches of the Embase, PubMed/MEDLINE and APA PsycINFO electronic databases for articles published from inception until February 2022. Published reviews, meta-analyses, randomised controlled trials and recent studies were prioritised to provide a comprehensive and up-to-date overview of research on brain stimulation in patients with bipolar disorders. RESULTS The evidence base for brain stimulation as an add-on or alternative to pharmacological and psychological treatments in patients with bipolar disorders is limited but rapidly expanding. Brain stimulation treatments represent an opportunity to treat all bipolar disorder states, including cognitive dysfunction during euthymic periods. CONCLUSION Whilst findings to date have been encouraging, larger randomised controlled trials with long-term follow-up are needed to clarify important questions regarding treatment efficacy and tolerability, the frequency of treatment-emergent affective switches and effects on cognitive function.
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Affiliation(s)
- Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Cheung T, Li TMH, Ho YS, Kranz G, Fong KNK, Leung SF, Lam SC, Yeung WF, Lam JYT, Fong KH, Beisteiner R, Xiang YT, Cheng CPW. Effects of Transcranial Pulse Stimulation (TPS) on Adults with Symptoms of Depression-A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032333. [PMID: 36767702 PMCID: PMC9915638 DOI: 10.3390/ijerph20032333] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 05/29/2023]
Abstract
Transcranial pulse stimulation (TPS) is a recent development in non-invasive brain stimulations (NIBS) that has been proven to be effective in terms of significantly improving Alzheimer patients' cognition, memory, and execution functions. Nonetheless, there is, currently, no trial evaluating the efficacy of TPS on adults with major depression disorder (MDD) nationwide. In this single-blinded, randomized controlled trial, a 2-week TPS treatment comprising six 30 min TPS sessions were administered to participants. Participants were randomized into either the TPS group or the Waitlist Control (WC) group, stratified by gender and age according to a 1:1 ratio. Our primary outcome was evaluated by the Hamilton depression rating scale-17 (HDRS-17). We recruited 30 participants that were aged between 18 and 54 years, predominantly female (73%), and ethnic Chinese from 1 August to 31 October 2021. Moreover, there was a significant group x time interaction (F(1, 28) = 18.8, p < 0.001). Further, when compared with the WC group, there was a significant reduction in the depressive symptom severity in the TPS group (mean difference = -6.60, p = 0.02, and Cohen's d = -0.93). The results showed a significant intervention effect; in addition, the effect was large and sustainable at the 3-month follow-up. In this trial, it was found that TPS is effective in reducing depressive symptoms among adults with MDD.
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Affiliation(s)
- Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Tim Man Ho Li
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuen Shan Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Georg Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Joyce Yuen Ting Lam
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kwan Hin Fong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Roland Beisteiner
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, University of Macau, Macao SAR, China
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Feasibility, Acceptability, and Efficacy of Home-Based Transcranial Direct Current Stimulation on Pain in Older Adults with Alzheimer's Disease and Related Dementias: A Randomized Sham-Controlled Pilot Clinical Trial. J Clin Med 2023; 12:jcm12020401. [PMID: 36675330 PMCID: PMC9860690 DOI: 10.3390/jcm12020401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023] Open
Abstract
Although transcranial direct current stimulation (tDCS) is emerging as a convenient pain relief modality for several chronic pain conditions, its feasibility, acceptability, and preliminary efficacy on pain in patients with Alzheimer's disease and related dementias (ADRD) have not been investigated. The purpose of this pilot study was to assess the feasibility, acceptability, and preliminary efficacy of 5, 20-min home-based tDCS sessions on chronic pain in older adults with ADRD. We randomly assigned 40 participants to active (n = 20) or sham (n = 20) tDCS. Clinical pain intensity was assessed using a numeric rating scale (NRS) with patients and a proxy measure (MOBID-2) with caregivers. We observed significant reductions of pain intensity for patients in the active tDCS group as reflected by both pain measures (NRS: Cohen's d = 0.69, p-value = 0.02); MOBID-2: Cohen's d = 1.12, p-value = 0.001). Moreover, we found home-based tDCS was feasible and acceptable intervention approach for pain in ADRD. These findings suggest the need for large-scale randomized controlled studies with larger samples and extended versions of tDCS to relieve chronic pain on the long-term for individuals with ADRD.
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Examining the synergistic effects of a cognitive control video game and a home-based, self-administered non-invasive brain stimulation on alleviating depression: the DiSCoVeR trial protocol. Eur Arch Psychiatry Clin Neurosci 2023; 273:85-98. [PMID: 36271928 PMCID: PMC9589526 DOI: 10.1007/s00406-022-01464-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
Enhanced behavioral interventions are gaining increasing interest as innovative treatment strategies for major depressive disorder (MDD). In this study protocol, we propose to examine the synergistic effects of a self-administered home-treatment, encompassing transcranial direct current stimulation (tDCS) along with a video game based training of attentional control. The study is designed as a two-arm, double-blind, randomized and placebo-controlled multi-center trial (ClinicalTrials.gov: NCT04953208). At three study sites (Israel, Latvia, and Germany), 114 patients with a primary diagnosis of MDD undergo 6 weeks of intervention (30 × 30 min sessions). Patients assigned to the intervention group receive active tDCS (anode F3 and cathode F4; 2 mA intensity) and an action-like video game, while those assigned to the control group receive sham tDCS along with a control video game. An electrode-positioning algorithm is used to standardize tDCS electrode positioning. Participants perform their designated treatment at the clinical center (sessions 1-5) and continue treatment at home under remote supervision (sessions 6-30). The endpoints are feasibility (primary) and safety, treatment efficacy (secondary, i.e., change of Montgomery-Åsberg Depression Rating Scale (MADRS) scores at week six from baseline, clinical response and remission, measures of social, occupational, and psychological functioning, quality of life, and cognitive control (tertiary). Demonstrating the feasibility, safety, and efficacy of this novel combined intervention could expand the range of available treatments for MDD to neuromodulation enhanced interventions providing cost-effective, easily accessible, and low-risk treatment options.ClinicalTrials.gov: NCT04953208.
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Rimmer RM, Costafreda SG, Mutz J, Joseph K, Brunoni AR, Loo CK, Padberg F, Palm U, Fu CH. Transcranial direct current stimulation effects in late life depression: A meta-analysis of individual participant data. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Optimized APPS-tDCS electrode position, size, and distance doubles the on-target stimulation magnitude in 3000 electric field models. Sci Rep 2022; 12:20116. [PMID: 36418438 PMCID: PMC9684449 DOI: 10.1038/s41598-022-24618-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a widely used noninvasive brain stimulation technique with mixed results to date. A potential solution is to apply more efficient stimulation to ensure that each participant receives sufficient cortical activation. In this four-part study, we used electric field (E-field) modeling to systematically investigate the cortical effects of conventional and novel tDCS electrode montages, with the goal of creating a new easily adoptable form of tDCS that induces higher and more focal E-fields. We computed 3000 anatomically accurate, MRI-based E-field models using 2 mA tDCS to target the left primary motor cortex in 200 Human Connectome Project (HCP) participants and tested the effects of: 1. Novel Electrode Position, 2. Electrode Size, and 3. Inter-Electrode Distance on E-field magnitude and focality. In particular, we examined the effects of placing electrodes surrounding the corticomotor target in the anterior and posterior direction (anterior posterior pad surround tDCS; APPS-tDCS). We found that electrode position, electrode size, and inter-electrode distance all significantly impact the cortical E-field magnitude and focality of stimulation (all p < 0.0001). At the same 2 mA scalp stimulation intensity, APPS-tDCS with smaller than conventional 1 × 1 cm electrodes surrounding the neural target deliver more than double the on-target cortical E-field (APPS-tDCS: average of 0.55 V/m from 2 mA; M1-SO and bilateral M1: both 0.27 V/m from 2 mA) while stimulating only a fraction of the off-target brain regions; 2 mA optimized APPS-tDCS produces 4.08 mA-like cortical E-fields. In sum, this new optimized APPS-tDCS method produces much stronger cortical stimulation intensities at the same 2 mA scalp intensity. APPS-tDCS also more focally stimulates the cortex at the intended target, using simple EEG coordinate locations and without MRI scans. This APPS-tDCS method is adoptable to any existing, commercially available tDCS device and can be used to ensure sufficient cortical activation in each person. Future directions include testing whether APPS-tDCS produces larger and more consistent therapeutic tDCS effects.
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Ngan STJ, Chan LK, Chan WC, Lam LCW, Li WK, Lim K, Or E, Pang PF, Poon TK, Wong MCM, Wu YKA, Cheng PWC. High-definition transcranial direct current stimulation (HD-tDCS) as augmentation therapy in late-life depression (LLD) with suboptimal response to treatment-a study protocol for a double-blinded randomized sham-controlled trial. Trials 2022; 23:914. [PMID: 36307858 DOI: 10.1186/s13063-022-06855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late-life depression (LLD) has a poorer prognosis and higher relapse rate than younger adults, with up to one third of patients with LLD showing suboptimal response to antidepressant therapy. LLD has been associated with significant impairment in cognition and daily functioning. Few studies have evaluated the therapeutic effects of high-definition transcranial direct current stimulation (HD-tDCS) on depressive and cognitive symptoms of LLD. The current randomized controlled trial assesses the efficacy of HD-tDCS as an augmentation therapy with antidepressants compared to sham-control in subjects with LLD. METHODS Fifty-eight patients with LLD will be recruited and randomly assigned to the active HD-tDCS or sham HD-tDCS group. In both groups, patients will receive the active or sham intervention in addition to their pre-existing antidepressant therapy, for 2 weeks with 5 sessions per week, each lasting 30 min. The primary outcome measures will be the change of depressive symptoms, clinical response and the remission rate as measured with the Hamilton Depression Rating scale (HAMD-17) before and after the intervention, and at the 4th and 12th week after the completed intervention. Secondary outcome measures include cognitive symptoms, anxiety symptoms, daily functioning and adverse effects. DISCUSSION: Older adults with depression are associated with poorer outcomes or unsatisfactory responses to antidepressant therapy, and significant cognitive decline. Therefore, a new effective treatment option is needed. This randomized control trial aims at assessing the efficacy of HD-tDCS on ameliorating the depressive, cognitive and anxiety symptoms, and improving the daily functioning of subjects with LLD. TRIAL REGISTRATION ClinicalTrials.gov NCT05322863. Registered on 11 April 2022.
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Affiliation(s)
- Sze Ting Joanna Ngan
- New Clinical Building, Queen Mary Hospital, 2/F, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong, Hong Kong
| | - Lap Kei Chan
- Department of Psychiatry, Kwai Chung Hospital, Kwai Chung, Hong Kong, Hong Kong
| | - Wai Chi Chan
- New Clinical Building, Queen Mary Hospital, 2/F, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong, Hong Kong
| | - Linda Chiu Wa Lam
- Department of Psychiatry, Tai Po Hospital, G/F, Multi-Centre, Tai Po, Hong Kong, Hong Kong
| | - Wan Kei Li
- New Clinical Building, Queen Mary Hospital, 2/F, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong, Hong Kong
| | - Kelvin Lim
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ego Or
- New Clinical Building, Queen Mary Hospital, 2/F, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong, Hong Kong
| | - Pui Fai Pang
- Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong, Hong Kong
| | - Ting Keung Poon
- Department of Psychiatry, Kowloon Hospital, Kadoorie Hill, Hong Kong, Hong Kong
| | - Mei Cheung Mimi Wong
- Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong, Hong Kong
| | - Ying King Anna Wu
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, Hong Kong
| | - Pak Wing Calvin Cheng
- New Clinical Building, Queen Mary Hospital, 2/F, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong, Hong Kong.
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Uenishi S, Tamaki A, Yamada S, Yasuda K, Ikeda N, Mizutani-Tiebel Y, Keeser D, Padberg F, Tsuji T, Kimoto S, Takahashi S. Computational modeling of electric fields for prefrontal tDCS across patients with schizophrenia and mood disorders. Psychiatry Res Neuroimaging 2022; 326:111547. [PMID: 36240572 DOI: 10.1016/j.pscychresns.2022.111547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/30/2022] [Accepted: 10/01/2022] [Indexed: 02/25/2023]
Abstract
This cross-diagnostic study aims to computationally model electric field (efield) for prefrontal transcranial direct current stimulation in mood disorders and schizophrenia. Enrolled were patients with major depressive disorder (n = 23), bipolar disorder (n = 24), schizophrenia (n = 23), and healthy controls (n = 23). The efield was simulated using SimNIBS software (ver.2.1.1). Electrodes were placed at the left and right prefrontal areas and the current intensity was set to 2 mA intensity. Schizophrenia and major depressive disorder groups showed significantly lower 99.5th percentile efield strength than healthy controls. In voxel-wise analysis, patients with schizophrenia showed a significant reduction of simulated efield strength in the bilateral frontal lobe, cerebellum and brain stem compared with healthy controls. Among the patients with schizophrenia, reduction of simulated efield strength was not significantly correlated with psychiatric symptoms or global functioning. The patients with bipolar disorder showed no significant difference in simulated efield strength compared with healthy controls, and there was no significant difference between the clinical groups. Our results suggest attenuated electrophysiological response to transcranial direct current stimulation to the prefrontal cortex in patients with schizophrenia, and to some extent in patients with major depressive disorder.
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Affiliation(s)
- Shinya Uenishi
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan; Department of Psychiatry, Hidaka Hospital, Gobo, Japan.
| | - Atsushi Tamaki
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan; Department of Psychiatry, Hidaka Hospital, Gobo, Japan
| | - Shinichi Yamada
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Kasumi Yasuda
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Natsuko Ikeda
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan; Department of Psychiatry, Wakayama Prefectural Mental Health Care Center, Aridagawa, Japan
| | - Yuki Mizutani-Tiebel
- Department of Psychiatry and Psychotherapy, University Hospital LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital LMU Munich, Munich, Germany; Department of Radiology, University Hospital LMU Munich, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU Munich, Munich, Germany
| | - Tomikimi Tsuji
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Sohei Kimoto
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Shun Takahashi
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan; Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino, Japan; Clinical Research and Education Center, Asakayama General Hospital, Sakai, Japan
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Aust S, Brakemeier EL, Spies J, Herrera-Melendez AL, Kaiser T, Fallgatter A, Plewnia C, Mayer SV, Dechantsreiter E, Burkhardt G, Strauß M, Mauche N, Normann C, Frase L, Deuschle M, Böhringer A, Padberg F, Bajbouj M. Efficacy of Augmentation of Cognitive Behavioral Therapy With Transcranial Direct Current Stimulation for Depression: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:528-537. [PMID: 35442431 PMCID: PMC9021985 DOI: 10.1001/jamapsychiatry.2022.0696] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Major depressive disorder (MDD) affects approximately 10% of the population globally. Approximately 20% to 30% of patients with MDD do not sufficiently respond to standard treatment. Therefore, there is a need to develop more effective treatment strategies. OBJECTIVE To investigate whether the efficacy of cognitive behavioral therapy (CBT) for the treatment of MDD can be enhanced by concurrent transcranial direct current stimulation (tDCS). DESIGN, SETTING, AND PARTICIPANTS The double-blind, placebo-controlled randomized clinical trial PsychotherapyPlus was conducted at 6 university hospitals across Germany. Enrollment took place between June 2, 2016, and March 10, 2020; follow-up was completed August 27, 2020. Adults aged 20 to 65 years with a single or recurrent depressive episode were eligible. They were either not receiving medication or were receiving a stable regimen of antidepressant medication (selective serotonin reuptake inhibitor and/or mirtazapine). A total of 148 women and men underwent randomization: 53 individuals were assigned to CBT alone (group 0), 48 to CBT plus tDCS (group 1), and 47 to CBT plus sham-tDCS (group 2). INTERVENTIONS Participants attended a 6-week group intervention comprising 12 sessions of CBT. If assigned, tDCS was applied simultaneously. Active tDCS included stimulation with an intensity of 2 mA for 30 minutes (anode over F3, cathode over F4). MAIN OUTCOMES AND MEASURES The primary outcome was the change in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to posttreatment in the intention-to-treat sample. Scores of 0 to 6 indicate no depression; 7 to 19, mild depression; 20 to 34, moderate depression; and 34 and higher, severe depression. RESULTS A total of 148 patients (89 women, 59 men; mean [SD] age, 41.1 [13.7] years; MADRS score at baseline, 23.0 [6.4]) were randomized. Of these, 126 patients (mean [SD] age, 41.5 [14.0] years; MADRS score at baseline, 23.0 [6.3]) completed the study. In each of the intervention groups, intervention was able to reduce MADRS scores by a mean of 6.5 points (95% CI, 3.82-9.14 points). The Cohen d value was -0.90 (95% CI, -1.43 to -0.50), indicating a significant effect over time. However, there was no significant effect of group and no significant interaction of group × time, indicating the estimated additive effects were not statistically significant. There were no severe adverse events throughout the whole trial, and there were no significant differences of self-reported adverse effects during and after stimulation between groups 1 and 2. CONCLUSIONS AND RELEVANCE Based on MADRS score changes, this trial did not indicate superior efficacy of tDCS-enhanced CBT compared with 2 CBT control conditions. The study confirmed that concurrent group CBT and tDCS is safe and feasible. However, additional research on mechanisms of neuromodulation to complement CBT and other behavioral interventions is needed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02633449.
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Affiliation(s)
- Sabine Aust
- Charité–Universitätsmedizin Berlin, Department of Psychiatry, Campus Benjamin Franklin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Universität Greifswald, Greifswald, Germany
| | - Jan Spies
- Charité–Universitätsmedizin Berlin, Department of Psychiatry, Campus Benjamin Franklin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ana Lucia Herrera-Melendez
- Charité–Universitätsmedizin Berlin, Department of Psychiatry, Campus Benjamin Franklin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tim Kaiser
- Department of Clinical Psychology and Psychotherapy, Universität Greifswald, Greifswald, Germany
| | - Andreas Fallgatter
- Universitätsklinik für Psychiatrie und Psychotherapie, Neurophysiologie & Interventionelle Neuropsychiatrie, Tübingen Center for Mental Health, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Christian Plewnia
- Universitätsklinik für Psychiatrie und Psychotherapie, Neurophysiologie & Interventionelle Neuropsychiatrie, Tübingen Center for Mental Health, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Sarah V. Mayer
- Universitätsklinik für Psychiatrie und Psychotherapie, Neurophysiologie & Interventionelle Neuropsychiatrie, Tübingen Center for Mental Health, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Esther Dechantsreiter
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Maria Strauß
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Nicole Mauche
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine & Center for Basics in NeuroModulation, University of Freiburg, Freiburg, Germany
| | - Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine & Center for Basics in NeuroModulation, University of Freiburg, Freiburg, Germany
| | - Michael Deuschle
- Central Institute for Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Andreas Böhringer
- Central Institute for Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Malek Bajbouj
- Charité–Universitätsmedizin Berlin, Department of Psychiatry, Campus Benjamin Franklin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Le B, Alonzo A, Bull M, Kabourakis M, Martin D, Loo C. A Clinical Case Series of Acute and Maintenance Home Administered Transcranial Direct Current Stimulation in Treatment-Resistant Depression. J ECT 2022; 38:e11-e19. [PMID: 35613011 DOI: 10.1097/yct.0000000000000813] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS) is a noninvasive neurostimulation technique being translated clinically for the treatment of depression. There is limited research documenting the longer-term effectiveness and safety of tDCS treatment. This case series is the first report of remotely supervised, home-administered tDCS (HA-tDCS) for depression in a clinical setting. METHODS We report clinical, cognitive, and safety outcomes from 16 depressed patients who received acute and/or maintenance HA-tDCS. We retrospectively examined clinical data from up to 2.5 years of treatment. Descriptive statistics are reported to document patient outcomes. RESULTS Twelve patients received acute treatment for a current depressive episode and 4 commenced tDCS maintenance therapy after responding to ECT or repetitive transcranial magnetic stimulation (rTMS). The cohort was highly treatment-resistant wherein 15 of 16 patients failed 3 trials or more of antidepressant medication in the current episode, and 6 patients failed to gain significant benefit from prior ECT or rTMS. Five of 12 patients responded to acute tDCS within 6 weeks, and 9 patients who received tDCS for more than 12 weeks maintained improvements over several months. Cognitive tests showed no evidence of impairments in cognitive outcomes after up to 2 years of treatment. Two patients were withdrawn from treatment because of blurred vision or exacerbation of tinnitus. Transcranial direct current stimulation was otherwise safe and well tolerated. CONCLUSIONS Transcranial direct current stimulation given for at least 6 weeks may be of clinical benefit even in treatment-resistant depression. Results provide support for long-term effectiveness, safety, and feasibility of remotely supervised HA-tDCS and suggest a role for maintenance tDCS after acute treatment with tDCS, rTMS, or ECT.
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Affiliation(s)
- Brandon Le
- From the School of Psychiatry, University of New South Wales/ Black Dog Institute, Randwick, NSW, Australia
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Gbadamosi IT, Henneh IT, Aluko OM, Yawson EO, Fokoua AR, Koomson A, Torbi J, Olorunnado SE, Lewu FS, Yusha'u Y, Keji-Taofik ST, Biney RP, Tagoe TA. Depression in Sub-Saharan Africa. IBRO Neurosci Rep 2022; 12:309-322. [PMID: 35746974 PMCID: PMC9210463 DOI: 10.1016/j.ibneur.2022.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/14/2022] [Indexed: 12/23/2022] Open
Abstract
Mood disorders can be considered among the most common and debilitating mental disorders. Major depression, as an example of mood disorders, is known to severely reduce the quality of life as well as psychosocial functioning of those affected. Its impact on the burden of disease worldwide has been enormous, with the World Health Organisation projecting depression to be the leading cause of mental illness by 2030. Despite several studies on the subject, little has been done to contextualise the condition in Africa, coupled with the fact that there is still much to be understood on the subject. This review attempts to shed more light on the prevalence of depression in Sub-Saharan Africa (SSA), its pathophysiology, risk factors, diagnosis and the experimental models available to study depression within the sub-region. It also evaluates the contribution of the sub-region to the global research output of depression as well as bottlenecks associated with full exploitation of the sub region's resources to manage the disorder.
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Affiliation(s)
- Ismail Temitayo Gbadamosi
- Department of Anatomy, University of Ilorin, Nigeria
- Laboratory for Translational Research in Neuropsychiatric Disorders, BRAINCITY Nencki-EMBL Center of Excellence for Neural Plasticty and Brain Disorders, Warsaw, Poland
| | - Isaac Tabiri Henneh
- Department of Pharmacotherapeutics and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Ghana
| | - Oritoke Modupe Aluko
- Department of Physiology, School of Basic Medical Sciences, Federal University of Technology, Akure, Nigeria
| | | | | | - Awo Koomson
- Department of Pharmacology and Toxicology University of Ghana, Ghana
| | - Joseph Torbi
- Department of Pharmacology and Toxicology University of Ghana, Ghana
| | | | | | - Yusuf Yusha'u
- Department of Human Physiology Ahmadu Bello University, Zaria, Nigeria
| | | | - Robert Peter Biney
- Department of Pharmacotherapeutics and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Ghana
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Caulfield KA, Indahlastari A, Nissim NR, Lopez JW, Fleischmann HH, Woods AJ, George MS. Electric Field Strength From Prefrontal Transcranial Direct Current Stimulation Determines Degree of Working Memory Response: A Potential Application of Reverse-Calculation Modeling? Neuromodulation 2022; 25:578-587. [PMID: 35670064 DOI: 10.1111/ner.13342] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) for working memory is an enticing treatment, but there is mixed evidence to date. OBJECTIVES We tested the effects of electric field strength from uniform 2 mA dosing on working memory change from prestimulation to poststimulation. Second, we statistically evaluated a reverse-calculation method of individualizing tDCS dose and its effect on normalizing electric field at the cortex. MATERIALS AND METHODS We performed electric field modeling on a data set of 28 healthy older adults (15 women, mean age = 73.7, SD = 7.3) who received ten sessions of active 2 mA tDCS (N = 14) or sham tDCS (N = 14) applied over bilateral dorsolateral prefrontal cortices (DLPFC) in a triple-blind design. We evaluated the relationship between electric field strength and working memory change on an N-back task in conditions of above-median, high electric field from active 2 mA (N = 7), below-median, low electric field from active 2 mA (N = 7), and sham (N = 14) at regions of interest (ROI) at the left and right DLPFC. We then determined the individualized reverse-calculation dose to produce the group average electric field and measured the electric field variance between uniform 2 mA doses vs individualized reverse-calculation doses at the same ROIs. RESULTS Working memory improvements from pre- to post-tDCS were significant for the above-median electric field from active 2 mA condition at the left DLPFC (mixed ANOVA, p = 0.013). Furthermore, reverse-calculation modeling significantly reduced electric field variance at both ROIs (Levene's test; p < 0.001). CONCLUSIONS Higher electric fields at the left DLPFC from uniform 2 mA doses appear to drive working memory improvements from tDCS. Individualized doses from reverse-calculation modeling significantly reduce electric field variance at the cortex. Taken together, using reverse-calculation modeling to produce the same, high electric fields at the cortex across participants may produce more effective future tDCS treatments for working memory.
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Affiliation(s)
- Kevin A Caulfield
- Brain Stimulation Laboratory, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA.
| | - Aprinda Indahlastari
- Center for Cognitive Aging and Memory Clinical Translational Research, McKnight Brain Institute, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Nicole R Nissim
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - James W Lopez
- Brain Stimulation Laboratory, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Holly H Fleischmann
- Brain Stimulation Laboratory, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory Clinical Translational Research, McKnight Brain Institute, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Mark S George
- Brain Stimulation Laboratory, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Labree B, Hoare DJ, Gascoyne LE, Scutt P, Del Giovane C, Sereda M. Determining the Effects of Transcranial Direct Current Stimulation on Tinnitus, Depression, and Anxiety: A Systematic Review. Brain Sci 2022; 12:brainsci12040484. [PMID: 35448015 PMCID: PMC9029345 DOI: 10.3390/brainsci12040484] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Tinnitus is the awareness of a sound in the absence of an external source. It affects around 10–15% of people, a significant proportion of whom also experience symptoms such as depression or anxiety that negatively affect their quality of life. Transcranial direct current stimulation (tDCS) is a technique involving constant low-intensity direct current delivered via scalp electrodes. It is a potential treatment option for tinnitus, as well as tinnitus-related conditions such as depression and anxiety. This systematic review estimates the effects of tDCS on outcomes relevant to tinnitus. In addition, it sheds light on the relationship between stimulation parameters and the effect of tDCS on these outcomes; (2) Methods: Exhaustive searches of electronic databases were conducted. Randomised controlled trials were included if they reported at least one of the following outcomes: tinnitus symptom severity, anxiety, or depression. Where available, data on quality of life, adverse effects, and neurophysiological changes were also reviewed. GRADE was used to assess the certainty in the estimate; (3) Results: Meta-analyses revealed a statistically significant reduction in tinnitus (moderate certainty) and depression (low certainty)-but not anxiety-following active tDCS compared to sham control. Network meta-analyses revealed potential optimal stimulation parameters; (4) Conclusions: The evidence synthesised in this review suggests tDCS has the potential to reduce symptom severity in tinnitus and depression. It further narrows down the number of potentially optimal stimulation parameters.
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Affiliation(s)
- Bas Labree
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; (D.J.H.); (P.S.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Correspondence:
| | - Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; (D.J.H.); (P.S.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Lauren E. Gascoyne
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham NG7 2XQ, UK;
| | - Polly Scutt
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; (D.J.H.); (P.S.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Cinzia Del Giovane
- Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, 41124 Modena, Italy;
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; (D.J.H.); (P.S.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
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Tolerability and feasibility of at-home remotely supervised transcranial direct current stimulation (RS-tDCS): Single-center evidence from 6,779 sessions. Brain Stimul 2022; 15:707-716. [DOI: 10.1016/j.brs.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/25/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022] Open
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Cheng YC, Kuo PH, Su MI, Huang WL. The efficacy of non-invasive, non-convulsive electrical neuromodulation on depression, anxiety and sleep disturbance: a systematic review and meta-analysis. Psychol Med 2022; 52:801-812. [PMID: 35105413 DOI: 10.1017/s0033291721005560] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The effects of non-invasive, non-convulsive electrical neuromodulation (NINCEN) on depression, anxiety and sleep disturbance are inconsistent in different studies. Previous meta-analyses on transcranial direct current stimulation (tDCS) and cerebral electrotherapy stimulation (CES) suggested that these methods are effective on depression. However, not all types of NINECN were included; results on anxiety and sleep disturbance were lacking and the influence of different populations and treatment parameters was not completely analyzed. We searched PubMed, Embase, PsycInfo, PsycArticles and CINAHL before March 2021 and included published randomized clinical trials of all types of NINCEN for symptoms of depression, anxiety and sleep in clinical and non-clinical populations. Data were pooled using a random-effects model. The main outcome was change in the severity of depressive symptoms after NINCEN treatment. A total of 58 studies on NINCEN were included in the meta-analysis. Active tDCS showed a significant effect on depressive symptoms (Hedges' g = 0.544), anxiety (Hedges' g = 0.667) and response rate (odds ratio = 1.9594) compared to sham control. CES also had a significant effect on depression (Hedges' g = 0.654) and anxiety (Hedges' g = 0.711). For all types of NINCEN, active stimulation was significantly effective on depression, anxiety, sleep efficiency, sleep latency, total sleep time, etc. Our results showed that tDCS has significant effects on both depression and anxiety and that these effects are robust for different populations and treatment parameters. The rational expectation of the tDCS effect is 'response' rather than 'remission'. CES also is effective for depression and anxiety, especially in patients with disorders of low severity.
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Affiliation(s)
- Ying-Chih Cheng
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
- Department of Public Health and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Department of Public Health and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Min-I Su
- Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Cerebellar Research Center, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
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Cheung T, Ho YS, Yeung JWF, Leung SF, Fong KNK, Fong T, Kranz GS, Beisteiner R, Cheng CPW. Effects of Transcranial Pulse Stimulation (TPS) on Young Adults With Symptom of Depression: A Pilot Randomised Controlled Trial Protocol. Front Neurol 2022; 13:861214. [PMID: 35401418 PMCID: PMC8990306 DOI: 10.3389/fneur.2022.861214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
Background Since the emergence of the COVID-19 pandemic, there have been lots of published work examining the association between COVID-19 and mental health, particularly, anxiety and depression in the general populations and disease subpopulations globally. Depression is a debilitating disorder affecting individuals' level of bio-psychological-social functioning across different age groups. Since almost all studies were cross-sectional studies, there seems to be a lack of robust, large-scale, and technological-based interventional studies to restore the general public's optimal psychosocial wellbeing amidst the COVID-19 pandemic. Transcranial pulse stimulation (TPS) is a relatively new non-intrusive brain stimulation (NIBS) technology, and only a paucity of studies was conducted related to the TPS treatment on older adults with mild neurocognitive disorders. However, there is by far no study conducted on young adults with major depressive disorder nationwide. This gives us the impetus to execute the first nationwide study evaluating the efficacy of TPS on the treatment of depression among young adults in Hong Kong. Methods This study proposes a two-armed single-blinded randomised controlled trial including TPS as an intervention group and a waitlist control group. Both groups will be measured at baseline (T1), immediately after the intervention (T2), and at the 3- month follow-up (T3). Recruitment A total of 30 community-dwelling subjects who are aged 18 and above and diagnosed with major depressive disorder (MDD) will be recruited in this study. All subjects will be computer randomised into either the intervention group or the waitlist control group, balanced by gender and age on a 1:1 ratio. Intervention All subjects in each group will have to undertake functional MRI (fMRI) before and after six 30-min TPS sessions, which will be completed in 2 weeks' time. Outcomes Baseline measurements and post-TPS evaluation of the psychological outcomes (i.e., depression, cognition, anhedonia, and instrumental activities of daily living) will also be conducted on all participants. A 3-month follow-up period will be usedto assess the long-term sustainability of the TPS intervention. For statistical analysis, ANOVA with repeated measures will be used to analyse data. Missing data were managed by multiple mutations. The level of significance will be set to p < 0.05. Significance of the Study Results of this study will be used to inform health policy to determine whether TPS could be considered as a top treatment option for MDD. Clinical Trial Registration ClinicalTrials.gov, identifier: NCT05006365.
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Affiliation(s)
- Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Yuen Shan Ho
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jerry Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Tommy Fong
- Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Georg S. Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Roland Beisteiner
- Department of Neurology, Functional Diagnostics and Therapy, Medical University of Vienna, Vienna, Austria
| | - Calvin Pak Wing Cheng
- Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Lõokene M, Markov N, Nikander M, Neuvonen T, Dilkov D. REDUCTION OF SYMPTOMS IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER AFTER TRANSCRANIAL DIRECT CURRENT STIMULATION TREATMENT: A REAL-WORLD STUDY. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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45
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Oh J, Jang KI, Jeon S, Chae JH. Effect of Self-administered Transcranial Direct Stimulation in Patients with Major Depressive Disorder: A Randomized, Single-blinded Clinical Trial. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2022; 20:87-96. [PMID: 35078951 PMCID: PMC8813309 DOI: 10.9758/cpn.2022.20.1.87] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/27/2020] [Accepted: 12/31/2020] [Indexed: 11/18/2022]
Abstract
Objective In numerous studies that have addressed transcranial direct current stimulation (tDCS) devices, participants visit the hospital regularly and undergo stimulation directed by health professionals. This method has the advantage of being able to deliver accurate stimuli in a controlled environment, but it does not adopt the merits of tDCS portability and applicability. Thus, it may be necessary to investigate how self-administered tDCS treatment at home affects depression-related symptoms. Methods In this randomized, single-blinded clinical trial, 58 patients with major depressive disorder were assigned to active and sham tDCS stimulation groups, and treatment responses were evaluated biweekly over six weeks. Both active and sham tDCS treatment group were treated with escitalopram. All participants were instructed the protocol and usage of at-home tDCS device, and self-administered tDCS treatment at their home. Results The beck-depression inventory score decreased significantly as treatment progressed, and the degree of symptom improvement was significantly higher in the active group than in the sham tDCS group. There were no significant differences between the two groups in other indices, including the Hamilton Depression Scale. Conclusion These results suggest that patient-administered tDCS treatment might be effective in improving subjective symptoms of depression.
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Affiliation(s)
- Jihoon Oh
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kuk-In Jang
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sekye Jeon
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Cappon D, den Boer T, Jordan C, Yu W, Lo A, LaGanke N, Biagi MC, Skorupinski P, Ruffini G, Morales O, Metzger E, Manor B, Pascual-Leone A. Safety and Feasibility of Tele-Supervised Home-Based Transcranial Direct Current Stimulation for Major Depressive Disorder. Front Aging Neurosci 2022; 13:765370. [PMID: 35185515 PMCID: PMC8849231 DOI: 10.3389/fnagi.2021.765370] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/08/2021] [Indexed: 12/23/2022] Open
Abstract
Major depressive disorder (MDD) is a worldwide cause of disability in older age, especially during the covid pandemic. Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that has shown encouraging efficacy for treatment of depression. Here, we investigate the feasibility of an innovative protocol where tDCS is administered within the homes of older adults with MDD (patient participants) with the help of a study companion (i.e. caregiver). We further analyze the feasibility of a remotely-hosted training program that provides the knowledge and skills to administer tDCS at home, without requiring them to visit the lab. We also employed a newly developed multi-channel tDCS system with real-time monitoring designed to guarantee the safety and efficacy of home-based tDCS. Patient participants underwent a total of 37 home-based tDCS sessions distributed over 12 weeks. The protocol consisted of three phases each lasting four weeks: an acute phase, containing 28 home-based tDCS sessions, a taper phase containing nine home-based tDCS sessions, and a follow up phase, with no stimulation sessions. We found that the home-based, remotely-supervised, study companion administered, multi-channel tDCS protocol for older adults with MDD was feasible and safe. Further, the study introduces a novel training program for remote instruction of study companions in the administration of tDCS. Future research is required to determine the translatability of these findings to a larger sample.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT04799405?term=NCT04799405&draw=2&rank=1, identifier NCT04799405.
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Affiliation(s)
- Davide Cappon
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- *Correspondence: Davide Cappon,
| | - Tim den Boer
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Caleb Jordan
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
| | - Wanting Yu
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Alexander Lo
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | - Nicole LaGanke
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
| | | | | | | | - Oscar Morales
- Department of Psychiatry Harvard Medical School, Boston, MA, United States
| | - Eran Metzger
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Department of Psychiatry Harvard Medical School, Boston, MA, United States
| | - Bradley Manor
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, MA, United States
- Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Guttmann Brain Health Institute, Barcelona, Spain
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No effects of transcranial direct current stimulation on visual evoked potential and peak gamma frequency. Cogn Process 2022; 23:235-254. [PMID: 35099659 DOI: 10.1007/s10339-022-01076-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/12/2022] [Indexed: 11/03/2022]
Abstract
Evidence suggests that the visual evoked potential (VEP) and gamma oscillations elicited by visual stimuli reflect the balance of excitatory and inhibitory (E-I) cortical processes. As tDCS has been shown to modulate E-I balance, the current study investigated whether amplitudes of VEP components (N1 and P2) and peak gamma frequency are modulated by transcranial direct current stimulation (tDCS). Healthy adults underwent two electroencephalography (EEG) recordings while viewing stimuli designed to elicit a robust visual response. Between the two recordings, participants were randomly assigned to three tDCS conditions (anodal-, cathodal-, and sham-tDCS) or received no-tDCS. tDCS electrodes were placed over the occipital cortex (Oz) and the left cheek with an intensity of 2 mA for 10 min. Data of 39 participants were analysed for VEP amplitudes and peak gamma frequency using mixed-model ANOVAs. The results showed no main effects of tDCS in any metric. Possible explanations for the absence of tDCS effects are discussed.
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Cho H, Razza LB, Borrione L, Bikson M, Charvet L, Dennis-Tiwary TA, Brunoni AR, Sudbrack-Oliveira P. Transcranial Electrical Stimulation for Psychiatric Disorders in Adults: A Primer. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:19-31. [PMID: 35746931 PMCID: PMC9063596 DOI: 10.1176/appi.focus.20210020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Transcranial electrical stimulation (tES) comprises noninvasive neuromodulation techniques that deliver low-amplitude electrical currents to targeted brain regions with the goal of modifying neural activities. Expanding evidence from the past decade, specifically using transcranial direct current simulation and transcranial alternating current stimulation, presents promising applications of tES as a treatment for psychiatric disorders. In this review, the authors discuss the basic technical aspects and mechanisms of action of tES in the context of clinical research and practice and review available evidence for its clinical use, efficacy, and safety. They also review recent advancements in use of tES for the treatment of depressive disorders, schizophrenia, substance use disorders, and obsessive-compulsive disorder. Findings largely support growing evidence for the safety and efficacy of tES in the treatment of patients with resistance to existing treatment options, particularly demonstrating promising treatment outcomes for depressive disorders. Future directions of tES research for optimal application in clinical settings are discussed, including the growing home-based, patient-friendly methods and the potential pairing with existing pharmacological or psychotherapeutic treatments for enhanced outcomes. Finally, neuroimaging advancements may provide more specific mapping of brain networks, aiming at more precise tES therapeutic targeting in the treatment of psychiatric disorders.
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Affiliation(s)
- Hyein Cho
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Lais B Razza
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Lucas Borrione
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Marom Bikson
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Leigh Charvet
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Tracy A Dennis-Tiwary
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Andre R Brunoni
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
| | - Pedro Sudbrack-Oliveira
- Department of Psychology, Graduate Center, and Department of Psychology, Hunter College, City University of New York, New York City (Cho, Dennis-Tiwary); Department and Institute of Psychiatry and Service of Interdisciplinary Neuromodulation, Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Razza, Borrione, Brunoni, Sudbrack-Oliveira); Department of Biomedical Engineering, City College of New York, City University of New York, New York City (Bikson); Department of Neurology, Grossman School of Medicine, New York University, New York City (Charvet); Department of Internal Medicine, Faculty of Medicine, University of São Paulo, and University Hospital, University of São Paulo, São Paulo, Brazil (Brunoni)
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49
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Abstract
Despite the prevalence of anhedonia across multiple psychiatric disorders, its relevance to treatment selection and prognostication can be unclear (Davey et al., Psychol Med 42(10):2071-81, 2012). Given the challenges in pharmacological and psychosocial treatment, there has been increasing attention devoted to neuroanatomically-targeted treatments. This chapter will present a brief introduction to circuit-targeted therapeutics in psychiatry (Sect. 1), an overview of brain mapping as it relates to anhedonia (Sect. 2), a review of existing studies on brain stimulation for anhedonia (Sect. 3), and a description of emerging approaches to circuit-based neuromodulation for anhedonia (Sect. 4).
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Affiliation(s)
- Shan H Siddiqi
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA.
| | - Nichola Haddad
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA
| | - Michael D Fox
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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50
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Wang J, Luo H, Schülke R, Geng X, Sahakian BJ, Wang S. 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. BMC Med 2021; 19:319. [PMID: 34915885 PMCID: PMC8680114 DOI: 10.1186/s12916-021-02181-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/08/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) has shown mixed results for depression treatment. The efficacies of tDCS combination therapies have not been investigated deliberately. This review aims to evaluate the clinical efficacy of tDCS as a monotherapy and in combination with medication, psychotherapy, and ECT for treating adult patients with major depressive disorder (MDD) and identified the factors influencing treatment outcome measures (i.e. depression score, dropout, response, and remission rates). METHODS The systematic review was performed in PubMed/Medline, EMBASE, PsycINFO, Web of Sciences, and OpenGrey. Two authors performed independent literature screening and data extraction. The primary outcomes were the standardized mean difference (SMD) for continuous depression scores after treatment and odds ratio (OR) dropout rate; secondary outcomes included ORs for response and remission rates. Random effects models with 95% confidence intervals were employed in all outcomes. The overall effect of tDCS was investigated by meta-analysis. Sources of heterogeneity were explored via subgroup analyses, meta-regression, sensitivity analyses, and assessment of publication bias. RESULTS Twelve randomised, sham-controlled trials (active group: N = 251, sham group: N = 204) were included. Overall, the integrated depression score of the active group after treatment was significantly lower than that of the sham group (g = - 0.442, p = 0.017), and further analysis showed that only tDCS + medication achieved a significant lower score (g = - 0.855, p < 0.001). Moreover, this combination achieved a significantly higher response rate than sham intervention (OR = 2.7, p = 0.006), while the response rate remained unchanged for the other three therapies. Dropout and remission rates were similar in the active and sham groups for each therapy and also for the overall intervention. The meta-regression results showed that current intensity is the only predictor for the response rate. None of publication bias was identified. CONCLUSION The effect size of tDCS treatment was obviously larger in depression score compared with sham stimulation. The tDCS combined selective serotonin re-uptake inhibitors is the optimized therapy that is effective on depression score and response rate. tDCS monotherapy and combined psychotherapy have no significant effects. The most important parameter for optimization in future trials is treatment strategy.
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Affiliation(s)
- Jingying Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.,Shanghai Engineering Research Center of AI & Robotics, Fudan University, Shanghai, China.,Engineering Research Center of AI & Robotics, Ministry of Education, 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, 220 Handan Road, Yangpu District, Shanghai, 200433, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China.,Shanghai Engineering Research Center of AI & Robotics, Fudan University, Shanghai, China.,Engineering Research Center of AI & Robotics, Ministry of Education, Fudan University, Shanghai, China
| | - Barbara J Sahakian
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433, China.,Department of Psychiatry, University of Cambridge, Cambridge, UK.,Behavioural Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433, China. .,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China. .,Shanghai Engineering Research Center of AI & Robotics, Fudan University, Shanghai, China. .,Engineering Research Center of AI & Robotics, Ministry of Education, Fudan University, Shanghai, China.
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