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The Impact of Transcranial Direct Current Stimulation (tDCS) on Bipolar Depression, Mania, and Euthymia: a Systematic Review of Preliminary Data

The Impact of Transcranial Direct Current Stimulation (tDCS) on Bipolar Depression, Mania, and Euthymia: a Systematic Review of Preliminary Data

Article Date: (Revised: 2019-01-03)
Authors: Dondé C, Neufeld NH, Geoffroy PA
PMID Link: 29785673


Journal Information
Title: The Psychiatric quarterly
Abbreviation: Psychiatr Q
Volume: 89
Issue: 4
Date: 2018-12-01
Citation: Psychiatr Q 2018 12;89(4):855-867

Abstract

The neurobiological basis of bipolar disorders (BD) has received increased attention and several brain regions and brain circuits have been correlated with clinical symptoms. These brain regions and circuits may represent targets for neuromodulation techniques such as transcranial Direct Current Stimulation (tDCS). We systematically reviewed the literature to explore the risks and benefits of tDCS in BD and examined all mood states. Following the PRISMA guidelines, a systematic literature search using several databases was performed from April 2002 to June 2017. From the 135 eligible studies, we retained 19 relevant articles for the systematic review, including 170 patients with BD treated by tDCS. Data from 10 studies suggest that tDCS improves depressive symptoms in BD. One case report of add-on-tDCS reported a significant positive response on manic symptoms. In 4 studies, tDCS impacted specific neurocognitive functions in euthymic patients. There is also preliminary evidence that tDCS improves neurological soft signs and sleep quality in euthymia. Side effects were predominantly transient and low-intensity, although 6 cases of hypomanic/manic affective switches have been reported. The majority of studies have been open trials with few patients. More sufficiently powered randomized controlled trials are needed to clarify the effectiveness of tDCS. Preliminary data suggests that tDCS holds promise as a treatment for BD, especially during depressive episodes. Perhaps most promising are emerging data suggesting tDCS may impact neurocognition and sleep quality in euthymia and be useful for relapse prevention.

Repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant major depression (TRMD) Veteran patients: study protocol for a randomized controlled trial

Repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant major depression (TRMD) Veteran patients: study protocol for a randomized controlled trial

Article Date: 2017-09-02 (Revised: 2018-11-13)
Authors: Mi Z, Biswas K, Fairchild JK, Davis-Karim A, Phibbs CS, Forman SD, Thase M, Georgette G, Beale T, Pittman D, McNerney MW, Rosen A, Huang GD, George M, Noda A, Yesavage JA
PMID Link: 28865495

Journal Information
Title: Trials
Abbreviation: Trials
Volume: 18
Issue: 1
Date: 2017-09-02
Citation: Trials 2017 09;18(1):409

Abstract

BACKGROUND: Evaluation of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant major depression (TRMD) in Veterans offers unique clinical trial challenges. Here we describe a randomized, double-blinded, intent-to-treat, two-arm, superiority parallel design, a multicenter study funded by the Cooperative Studies Program (CSP No. 556) of the US Department of Veterans Affairs.

METHODS: We recruited medical providers with clinical expertise in treating TRMD at nine Veterans Affairs (VA) medical centers as the trial local investigators. We plan to enroll 360 Veterans diagnosed with TRMD at the nine VA medical centers over a 3-year period. We will randomize participants into a double-blinded clinical trial to left prefrontal rTMS treatment or to sham (control) rTMS treatment (180 participants each group) for up to 30 treatment sessions. All participants will meet Diagnostic and statistical manual of mental disorders, 4 edition (DSM-IV) criteria for major depression and will have failed at least two prior pharmacological interventions. In contrast with other rTMS clinical trials, we will not exclude Veterans with posttraumatic stress disorder (PTSD) or history of substance abuse and we will obtain detailed history regarding these disorders. Furthermore, we will maintain participants on stable anti-depressant medication throughout the trial. We will evaluate all participants on a wide variety of potential predictors of treatment response including cognitive, psychological and functional parameters.

DISCUSSION: The primary dependent measure will be remission rate (Hamilton Rating Scale for Depression (HRSD24) ≤ 10), and secondary analyses will be conducted on other indices. Comparisons between the rTMS and the sham groups will be made at the end of the acute treatment phase to test the primary hypothesis. The unique challenges to performing such a large technically challenging clinical trial with Veterans and potential avenues for improvement of the design in future trials will be described.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT01191333 . Registered on 26 August 2010. This report is based on the protocol version 4.6 amended in February 2016. All items from the World Health Organization Trial Registration Data Set are listed in Appendix A.

Multisession anodal transcranial direct current stimulation induces motor cortex plasticity enhancement and motor learning generalization in an aging population.

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Multisession anodal transcranial direct current stimulation induces motor cortex plasticity enhancement and motor learning generalization in an aging population.

Clin Neurophysiol. 2017 Nov 21;:

Authors: Dumel G, Bourassa MÈ, Charlebois-Plante C, Desjardins M, Doyon J, Saint-Amour D, De Beaumont L

Abstract
OBJECTIVES: The present aging study investigated the impact of a multisession anodal-tDCS protocol applied over the primary motor cortex (M1) during motor sequence learning on generalization of motor learning and plasticity-dependent measures of cortical excitability.
METHODS: A total of 32 cognitively-intact aging participants performed five consecutive daily 20-min sessions of the serial-reaction time task (SRTT) concomitant with either anodal (n = 16) or sham (n = 16) tDCS over M1. Before and after the intervention, all participants performed the Purdue Pegboard Test (PPT) and Transcranial Magnetic Stimulation (TMS) measures of cortical excitability were collected.
RESULTS: Relative to sham, participants assigned to the anodal-tDCS intervention revealed significantly greater performance gains on both the trained SRTT and the untrained PPT as well as a greater disinhibition of long-interval cortical inhibition (LICI). Generalization effects of anodal-tDCS significantly correlated with LICI disinhibition.
CONCLUSION: Anodal-tDCS facilitates motor learning generalisation in an aging population through intracortical disinhibition effects.
SIGNIFICANCE: The current findings demonstrate the potential clinical utility of a multisession anodal-tDCS over M1 protocol as an adjuvant to motor training in alleviating age-associated motor function decline. This study also reveals the pertinence of implementing brain stimulation techniques to modulate age-associated intracortical inhibition changes in order to facilitate motor function gains.

PMID: 29223355 [PubMed – as supplied by publisher]

Electrical brain stimulation (tES) improves learning more than performance: A meta-analysis.

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Electrical brain stimulation (tES) improves learning more than performance: A meta-analysis.

Neurosci Biobehav Rev. 2018 Jan;84:171-181

Authors: Simonsmeier BA, Grabner RH, Hein J, Krenz U, Schneider M

Abstract
Researchers have recently started evaluating whether stimulating the brain noninvasively with a weak and painless electrical current (transcranial Electrical Stimulation, tES) enhances physiological and cognitive processes. Some studies found that tES has weak but positive effects on brain physiology, cognition, or assessment performance, which has attracted massive public interest. We present the first meta-analytic test of the hypothesis that tES in a learning phase is more effective than tES in an assessment phase. The meta-analysis included 246 effect sizes from studies on language or mathematical competence. The effect of tES was stronger when stimulation was administered during a learning phase (d=0.712) as compared to stimulation administered during test performance (d=0.207). The overall effect was stimulation-dosage specific and, as found in a previous meta-analysis, significant only for anodal stimulation and not for cathodal. The results provide evidence for the modulation of long-term synaptic plasticity by tES in the context of practically relevant learning tasks and highlight the need for more systematic evaluations of tES in educational settings.

PMID: 29128578 [PubMed – indexed for MEDLINE]

Transcranial Direct Current Stimulation on Opium Craving, Depression, and Anxiety: A Preliminary Study

Transcranial Direct Current Stimulation on Opium Craving, Depression, and Anxiety: A Preliminary Study

Article Date: 2019-01-16 (Revised: 2019-01-21)
Authors: Taremian F, Nazari S, Moradveisi L, Moloodi R
PMID Link: 30664050


Journal Information
Title: The journal of ECT
Abbreviation: J ECT
Volume:
Issue:
Date: 2019-01-16
Citation: J ECT 2019 Jan;

Abstract

OBJECTIVES: Transcranial direct current stimulation can be effective in reducing the craving for food, alcohol, and methamphetamine. Because its effects have not been tested on patients with opium use disorder, we investigated its efficacy when it is combined with a standard methadone maintenance therapy protocol.

METHODS: We carried out a pretest-posttest control group method to evaluate the effect of transcranial direct current stimulation at the dorsolateral prefrontal cortex (right anodal/left cathodal) on opium craving, depression, and anxiety symptoms. We considered opium craving as a primary outcome as well as depression and anxiety symptoms as secondary outcomes. Sixty participants with opium use disorder were randomly assigned into 3 groups (n = 20 for each group): (1) an active transcranial direct current stimulation with methadone maintenance treatment (active tDCS group), (2) sham transcranial direct current stimulation with methadone maintenance treatment (sham tDCS group), and (3) only methadone maintenance treatment (methadone maintenance treatment group). All participants completed the Desire for Drug Questionnaire, Obsessive-Compulsive Drug Use Scale, Beck Depression Inventory II, and Beck Anxiety Inventory a week before and a week after the treatment. The outcomes were assessed by independent assessors who were blind to the treatment conditions.

RESULTS: The active tDCS group had a significant reduction in opium craving, depression, and anxiety symptoms compared with the other 2 groups.

CONCLUSIONS: Our results provide a preliminary support for using the transcranial direct current stimulation along with methadone maintenance therapy in the treatment of patients with opium use disorder.

Commentary: Efficacy and Safety of Transcranial Direct Current Stimulation as an Add-on Treatment for Bipolar Depression: A Randomized Clinical Trial

Commentary: Efficacy and Safety of Transcranial Direct Current Stimulation as an Add-on Treatment for Bipolar Depression: A Randomized Clinical Trial

Article Date: 2018-12-03 (Revised: 2018-12-25)
Authors: Hu ZY, Liu X, Zheng H, Zhou DS
PMID Link: 30574077


Journal Information
Title: Frontiers in human neuroscience
Abbreviation: Front Hum Neurosci
Volume: 12
Issue:
Date: 2018-01-01
Citation: Front Hum Neurosci 2018;12:480

Abstract

Hospital production cost of transcranial direct current stimulation (tDCS) in the treatment of depression

Hospital production cost of transcranial direct current stimulation (tDCS) in the treatment of depression

Article Date: 2018-11-27 (Revised: 2019-02-01)
Authors: Sauvaget A, Tostivint A, Etcheverrigaray F, Pichot A, Dert C, Schirr-Bonnais S, Clouet J, Sellal O, Mauduit N, Leux C, Cabelguen C, Bulteau S, Riche VP
PMID Link: 30502122


Journal Information
Title: Neurophysiologie clinique = Clinical neurophysiology
Abbreviation: Neurophysiol Clin
Volume: 49
Issue: 1
Date: 2019-02-01
Citation: Neurophysiol Clin 2019 Feb;49(1):11-18

Abstract

OBJECTIVES: Due to its ease of use, tolerance, and cost of acquisition, transcranial direct current stimulation (tDCS) could constitute a credible therapeutic option for non-resistant depression in primary care, when combined with drug management. This indication has yet to receive official recognition in France. The objective of this study is to evaluate the production cost of tDCS for the treatment of depression in hospitals, under realistic conditions.

METHODS: The methodology adopted is based on cost accounting and was validated by a multidisciplinary working group. It includes equipment, staff, and structural costs to obtain the most realistic estimate possible. We first estimated the cost of producing a tDCS session, based on our annual activity objective, and then estimated the cost of a 15-session treatment program. This was followed up with a sensitivity analysis applying appropriate parameters.

RESULTS: The hospital production cost of a tDCS depression treatment program for a single patient was estimated at €1555.60 euros: €99 in equipment costs, €1076.95 in staff costs, and €379.65 in structural costs.

CONCLUSION: This cost analysis should make it possible to draw up pricing proposals in compliance with regulations and health policy choices and to develop health-economic studies. This would ultimately lead to official recognition of tDCS treatment for depression in France and pave the way for studying various scenarios of coverage by the French national health insurance system.

Sleep Quality, Depression, and Quality of Life After Bilateral Anodal Transcranial Direct Current Stimulation in Patients with Parkinson’s Disease

Sleep Quality, Depression, and Quality of Life After Bilateral Anodal Transcranial Direct Current Stimulation in Patients with Parkinson’s Disease

Article Date: 2018-11-19 (Revised: 2019-02-15)
Authors: Hadoush H, Al-Sharman A, Khalil H, Banihani SA, Al-Jarrah M
PMID Link: 30449881


Journal Information
Title: Medical science monitor basic research
Abbreviation: Med Sci Monit Basic Res
Volume: 24
Issue:
Date: 2018-11-19
Citation: Med Sci Monit Basic Res 2018 Nov;24:198-205

Abstract

BACKGROUND Sleep dysfunctions impose a large burden on quality of life for patients with Parkinson’s disease (PD). Several studies on PD reported potential therapeutic effects of transcranial direct current stimulation (tDCS) on motor and non-motor functions, but not related to sleep quality. Therefore, the present study examined sleep quality, depression perception, and quality of life changes after bilateral anodal tDCS in patients with PD. MATERIAL AND METHODS Twenty-one patients (n=21) with PD underwent 10 sessions (20 min each, 5 per week) of bilateral anodal tDCS stimulation applied simultaneously over the left and right prefrontal and motor areas. The Pittsburgh Sleep Quality Index (PSQI) total score and sub-scores, Geriatric Depression Scale (GDS), and Health-related quality of life questionnaire (SF-36) were measured pre/post bilateral tDCS anodal stimulation. RESULTS PSQI total score (P=0.045), sleep latency sub-score (P=0.02), and GDS total score (P=0.016) significantly decreased, and physical and mental components scores of SF-36 (P=0.018 and P=0.001, respectively) significantly increased after bilateral anodal tDCS stimulation. The GDS score decrease was directly correlated with decrease in PSQI total score (P=0.01), sleep latency sub-score (P=0.002), and sleep disturbance sub-score (P=0.003). In addition, the GDS score decrease was inversely correlated with increasing mental component score of SF-36 (P=0.001), which was directly correlated with an increase in sleep efficiency sub-score (P=0.03) and the physical component score of SF-36 (P=0.0001). CONCLUSIONS Bilateral anodal tDCS stimulation showed potential therapeutic effects in patients with PD in terms of sleep quality and depression level improvement, which together improved mental and physical quality of life in patients with PD.

Quantifying clinical improvements in patients with depression under the treatment of transcranial direct current stimulation using event related potentials

Quantifying clinical improvements in patients with depression under the treatment of transcranial direct current stimulation using event related potentials

Article Date: 2018-11-02 (Revised: 2018-11-30)
Authors: Shahsavar Y, Ghoshuni M, Talaei A
PMID Link: 30390213


Journal Information
Title: Australasian physical & engineering sciences in medicine
Abbreviation: Australas Phys Eng Sci Med
Volume: 41
Issue: 4
Date: 2018-12-01
Citation: Australas Phys Eng Sci Med 2018 Dec;41(4):973-983

Abstract

The main goal of this study was to assess the changes in brain activities of patients with severe depression by applying transcranial direct current stimulation (tDCS) using event related potentials (ERPs). Seven patients (four males, with the mean age 34.85 ± 4.25) were asked to fill out Beck’s depression questionnaires. EEG signals of subjects were recorded during Stroop test. This test entailed 360 stimulations, which included 120 congruent, 120 incongruent, and 120 neutral stimulations lasting for 12 min. Subsequently, the dorso lateral prefrontal cortex in patients’ left hemisphere was stimulated for six sessions using tDCS. At the end of tDCS treatment period, subjects filled out Beck’s depression questionnaires again and EEG signal recordings were repeated simultaneously with Stroop test. Wavelet coefficients of EEG frequency bands in every stimulation type were extracted from ERP components. The changes in Beck score before and after tDCS were estimated using neural network model. The ERP results showed that the latency period of N400 component after applying tDCS decreased significantly. Moreover, a significant correlation was observed between percentage changes of congruent and incongruent accuracy and the increase in the average energy of wavelet coefficients in alpha band in Pz electrode with p = 0.0128, r = 0.9060 and p = 0.0037, r = 0.95, respectively. Additionally, the results of neural network model revealed that the changes in Beck score were estimated with an average error of 0.0519. Consequently, the improvement of depressed patients treated with tDCS could be estimated with good accuracy using average energy of wavelet coefficients in alpha band.

Treatment of major depression with a two-step tDCS protocol add-on to SSRI: Results from a naturalistic study

Treatment of major depression with a two-step tDCS protocol add-on to SSRI: Results from a naturalistic study

Article Date: 2018-10-03 (Revised: 2018-12-19)
Authors: Palm U, Goerigk S, Kirsch B, Bäumler L, Sarubin N, Hasan A, Brunoni AR, Padberg F
PMID Link: 30314900


Journal Information
Title: Brain stimulation
Abbreviation: Brain Stimul
Volume: 12
Issue: 1
Date: 2019-01-01
Citation: Brain Stimul 2019 Jan – Feb;12(1):195-197

Abstract