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Hypomania Induced by Bifrontal Transcranial Direct Current Stimulation in a Patient with Bipolar Depression

Hypomania Induced by Bifrontal Transcranial Direct Current Stimulation in a Patient with Bipolar Depression

Article Date: 2018-09-17 (Revised: 2018-11-14)
Authors: Chao PC, Chang CC, Chang HA
PMID Link: 30235920


Journal Information
Title: Psychiatry investigation
Abbreviation: Psychiatry Investig
Volume: 15
Issue: 9
Date: 2018-09-01
Citation: Psychiatry Investig 2018 Sep;15(9):914-915

Abstract

Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, has been increasingly used to treat bipolar depression. Researchers recently noticed the risk of tDCS-emergent mania/hypomania in depressed patients and started to evaluate this risk by launching a meta-analysis. Here we present a female with bipolar II depression who rapidly developed hypomanic switching during bifrontal tDCS.

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Feasibility of Computerized Cognitive-Behavioral Therapy Combined With Bifrontal Transcranial Direct Current Stimulation for Treatment of Major Depression

Feasibility of Computerized Cognitive-Behavioral Therapy Combined With Bifrontal Transcranial Direct Current Stimulation for Treatment of Major Depression

Article Date: 2018-08-28 (Revised: 2018-08-28)
Authors: Welch ES, Weigand A, Hooker JE, Philip NS, Tyrka AR, Press DZ, Carpenter LL
PMID Link: 30153360


Journal Information
Title: Neuromodulation : journal of the International Neuromodulation Society
Abbreviation: Neuromodulation
Volume:
Issue:
Date: 2018-08-28
Citation: Neuromodulation 2018 Aug;

Abstract

BACKGROUND: Cognitive behavioral therapy (CBT) is effective in the treatment of major depressive disorder (MDD). Transcranial Direct Current Stimulation (tDCS) has demonstrated preliminary antidepressant effects and beneficial effects on cognitive function.

OBJECTIVE: We investigated the feasibility and acceptability of using tDCS to enhance the effects of computer-based CBT for treatment of MDD.

MATERIALS AND METHODS: In a randomized, double-blind, sham-controlled study, 14 patients with MDD on stable or no pharmacotherapy received active or sham bifrontal tDCS for four weeks with concurrent CBT.

RESULTS: Ten participants completed the protocol. Three withdrew from the study because of lack of efficacy or dislike of the eCBT program. One was discontinued from the protocol by the investigators. Treatment was well tolerated, and most side-effects were mild and consistent with prior tDCS research. Pooled data from both groups showed significant baseline to endpoint improvement in depression (p = 0.008). Overall percent change on the HAMD-21 was 28.98%. The study was underpowered to detect differences in tDCS treatment groups.

CONCLUSIONS: Combining tDCS with computer-based CBT is feasible for MDD. Further work is needed to evaluate potential synergistic effects of combined tDCS and CBT.

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Transcranial Direct Current Stimulation (tDCS) for Depression during Pregnancy: Scientific Evidence and What Is Being Said in the Media-A Systematic Review

Transcranial Direct Current Stimulation (tDCS) for Depression during Pregnancy: Scientific Evidence and What Is Being Said in the Media-A Systematic Review

Article Date: 2018-08-14 (Revised: 2018-11-14)
Authors: Kurzeck AK, Kirsch B, Weidinger E, Padberg F, Palm U
PMID Link: 30110930


Journal Information
Title: Brain sciences
Abbreviation: Brain Sci
Volume: 8
Issue: 8
Date: 2018-08-14
Citation: Brain Sci 2018 Aug;8(8)

Abstract

Major depression is the most frequent morbidity in pregnancy. The first-line therapies, psychopharmacologic treatment and psychotherapy, are either insufficient or may cause severe or teratogenic adverse events. As a result of its local limitation to the patient’s brain, transcranial direct current stimulation (tDCS) could potentially be an ideal treatment for pregnant women with depression. A literature search was conducted in medical databases, globally published newspapers, search engines, and clinical trial registers to collect all articles on tDCS for the treatment of depression during pregnancy. The aim of this review was to investigate the scientific evidence of tDCS use for depression during pregnancy and to compare these results with the textual and emotional perception in the media as interventions during pregnancy are under particular surveillance. We detected 13 medical articles dealing with tDCS for depression in pregnancy. Overall, the scientific evidence as well as articles in the media for tDCS in pregnancy are sparse, but promising. Further studies are required in this specifically vulnerable population of pregnant women to generate evidence. It is likely that public interest will increase when the results of a pilot study in Canada are published.

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Clinical Usefulness of Therapeutic Neuromodulation for Major Depression: A Systematic Meta-Review of Recent Meta-Analyses

Clinical Usefulness of Therapeutic Neuromodulation for Major Depression: A Systematic Meta-Review of Recent Meta-Analyses

Article Date: 2018-07-17 (Revised: 2019-01-22)
Authors: McGirr A, Berlim MT
PMID Link: 30098660

Journal Information
Title: The Psychiatric clinics of North America
Abbreviation: Psychiatr. Clin. North Am.
Volume: 41
Issue: 3
Date: 2018-09-01
Citation: Psychiatr. Clin. North Am. 2018 09;41(3):485-503

Abstract

The authors conducted a meta-review of meta-analyses published in the past decade on therapeutic neuromodulation (ie, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, vagus nerve stimulation and deep brain stimulation) for major depression. Active repetitive transcranial magnetic stimulation and transcranial direct current stimulation have been generally associated with small to moderate effect sizes vis-à-vis their efficacy and with similar acceptability compared with sham. Vagus nerve stimulation and deep brain stimulation (although more challenging to investigate) have demonstrated preliminary effectiveness, particularly during longer-term follow-up.

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Commentary: Effectiveness of theta burst vs. high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomized non-inferiority trial

Commentary: Effectiveness of theta burst vs. high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomized non-inferiority trial

Article Date: 2018-06-25 (Revised: 2018-11-14)
Authors: Han C, Chen Z, Liu L
PMID Link: 29988538


Journal Information
Title: Frontiers in human neuroscience
Abbreviation: Front Hum Neurosci
Volume: 12
Issue:
Date: 2018-01-01
Citation: Front Hum Neurosci 2018;12:255

Abstract

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Plasma biomarkers in a placebo-controlled trial comparing tDCS and escitalopram efficacy in major depression

Plasma biomarkers in a placebo-controlled trial comparing tDCS and escitalopram efficacy in major depression

Article Date: 2018-06-09 (Revised: 2019-01-28)
Authors: Brunoni AR, Padberg F, Vieira ELM, Teixeira AL, Carvalho AF, Lotufo PA, Gattaz WF, Benseñor IM
PMID Link: 29894705


Journal Information
Title: Progress in neuro-psychopharmacology & biological psychiatry
Abbreviation: Prog. Neuropsychopharmacol. Biol. Psychiatry
Volume: 86
Issue:
Date: 2018-08-30
Citation: Prog. Neuropsychopharmacol. Biol. Psychiatry 2018 08;86:211-217

Abstract

BACKGROUND: Transcranial direct current stimulation (tDCS) holds promise as a therapeutic intervention for major depressive disorder (MDD). A more precise understanding of its underlying mechanisms may aid in the identification of subsets of patients responsive to tDCS within the context of precision psychiatry.

OBJECTIVE: In this ancillary investigation of the Escitalopram vs. Electrical Current Therapy for Treating Depression Clinical Study (ELECT-TDCS), we investigated whether plasma levels of several cytokines and neurotrophic factors associated with major depression or antidepressant response predicted tDCS effects.

METHODS: We examined, in 236 patients at 3 timepoints during a 10-week treatment course, plasma levels of nerve growth factor (NGF), brain-derived (BDNF), glial-cell line derived neurotrophic factor (GDNF), the interleukins (IL) IL-1ß, IL-6, IL-8, IL-10, IL-12p70, IL-18, IL-33, tumor necrosis factor-alpha (TNF-alpha), and its soluble receptors sTNFr1 and sTNFr2. General linear models and mixed-models analyses of variance were used to respectively assess whether plasma levels of these molecules (1) predicted tDCS antidepressant improvement and (2) changed over time.

RESULTS: After correction for multiple comparisons (false discovery rate method), NGF baseline levels predicted early depression improvement for tDCS vs. escitalopram, whilst other biomarkers did not significantly predict treatment improvement. The levels of IL12p70, IL10, IL-1ß, IL-8 and sTNFr1 decreased over time, regardless of allocation group and clinical response.

CONCLUSION: In general, peripheral biomarkers were not associated with the outcome. The post-hoc finding of baseline NGF levels predicting early depression improvement for tDCS should be explored in further studies.

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What is the nonverbal communication of depression? Assessing expressive differences between depressive patients and healthy volunteers during clinical interviews

What is the nonverbal communication of depression? Assessing expressive differences between depressive patients and healthy volunteers during clinical interviews

Article Date: 2018-06-09 (Revised: 2019-01-22)
Authors: Fiquer JT, Moreno RA, Brunoni AR, Barros VB, Fernandes F, Gorenstein C
PMID Link: 29957481


Journal Information
Title: Journal of affective disorders
Abbreviation: J Affect Disord
Volume: 238
Issue:
Date: 2018-10-01
Citation: J Affect Disord 2018 10;238:636-644

Abstract

BACKGROUND: It is unclear if individuals with Major Depressive Disorder (MDD) present different nonverbal behavior (NVB) compared with healthy individuals, and also if depression treatments affect NVB. In this study, we compared the NVB of MDD subjects and healthy controls. We also verified how MDD subjects’ NVB is affected by depression severity and acute treatments.

METHODS: We evaluated 100 MDD outpatients and 83 controls. We used a 21-category ethogram to assess the frequency of positive and negative NVB at baseline. MDD subjects were also assessed after eight weeks of treatment (pharmacotherapy or neuromodulation). We used the Wilcoxon signed-rank test to compare the NVB of MDD subjects and controls; beta regression models to verify associations between MDD severity and NVB; the Shapiro-Wilk test to verify changes in NVB after treatment; and logistic regression models to verify NVB associated with treatment response according to the Hamilton depression rating scale.

RESULTS: Compared with controls, MDD subjects presented higher levels of six negative NVB (shrug, head and lips down, adaptive hand gestures, frown and cry) and lower levels of two positive NVB (eye contact and smile). MDD subjects’ NVB was not associated with depression severity, and did not significantly change after depression treatment. Treatment responders showed more interpersonal proximity at baseline than non-responders.

LIMITATIONS: Our ethogram had no measure of behavior duration, and we had a short follow-up period.

CONCLUSIONS: MDD subjects have more negative and less positive social NVB than controls. Their nonverbal behavior remained stable after clinical response to acute depression treatments.

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A systematic review of noninvasive brain stimulation for post-stroke depression

A systematic review of noninvasive brain stimulation for post-stroke depression

Article Date: 2018-05-21 (Revised: 2019-01-15)
Authors: Bucur M, Papagno C
PMID Link: 29860185


Journal Information
Title: Journal of affective disorders
Abbreviation: J Affect Disord
Volume: 238
Issue:
Date: 2018-10-01
Citation: J Affect Disord 2018 10;238:69-78

Abstract

BACKGROUND: Post-stroke depression (PSD) is among the most frequent neuropsychiatric consequences of stroke, negatively affecting the patient’s functional recovery and the quality of life. While pharmacological therapy has limited efficacy and important side effects, new appropriate treatments based on specific physiological mechanisms for PSD remain to be developed. Non-invasive brain stimulation (NIBS) techniques, modulating brain plasticity, might offer valid, alternative strategies.

METHODS: We systematically searched four databases: MEDLINE, PsycARTICLES, PsycINFO and Web of Science, up to December 2017, using definite keywords, to identify studies on TMS and tDCS treatment for PSD.

RESULTS: Seven studies met the inclusion criteria and the results indicate that both tDCS and rTMS are safe and have very low side effects. The reported positive results, suggesting that these methods can be considered effective therapeutic options, are questionable, and a general statement about their efficacy for PSD is premature due to small sample sizes, heterogeneous methodologies, lack of uniform diagnostic criteria, and divergent data.

LIMITATIONS: The selected articles suffer lack of information about quality of life and daily living performance measures; in addition, the number of randomized controlled trials is small.

CONCLUSION (S): The aim of this review was to analyze current research in the clinical use of noninvasive brain stimulation (NIBS) in PSD treatment in order to verify whether there are alternative perspectives in the treatment of PSD. Given the present evidence, future research is needed to address methodological limitations and evaluate the long-term efficacy of these methods, alone and in combination with pharmacological treatment.

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Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: A systematic review and meta-analysis of randomised sham-controlled trials

Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: A systematic review and meta-analysis of randomised sham-controlled trials

Article Date: 2018-05-12 (Revised: 2019-02-15)
Authors: Mutz J, Edgcumbe DR, Brunoni AR, Fu CHY
PMID Link: 29763711


Journal Information
Title: Neuroscience and biobehavioral reviews
Abbreviation: Neurosci Biobehav Rev
Volume: 92
Issue:
Date: 2018-09-01
Citation: Neurosci Biobehav Rev 2018 09;92:291-303

Abstract

We examined the efficacy and acceptability of non-invasive brain stimulation in adult unipolar and bipolar depression. Randomised sham-controlled trials of transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS) and theta-burst stimulation (TBS), without co-initiation of another treatment, were included. We analysed effects on response, remission, all-cause discontinuation rates and continuous depression severity measures. Fifty-six studies met our criteria for inclusion (N = 3058, mean age = 44.96 years, 61.73% female). Response rates demonstrated efficacy of high-frequency rTMS over the left DLPFC (OR = 3.75, 95% CI [2.44; 5.75]), right-sided low-frequency rTMS (OR = 7.44, 95%CI [2.06; 26.83]) bilateral rTMS (OR = 3.68,95%CI [1.66; 8.13]), deep TMS (OR = 1.69, 95%CI [1.003; 2.85]), intermittent TBS (OR = 4.70, 95%CI [1.14; 19.38]) and tDCS (OR = 4.17, 95% CI [2.25; 7.74]); but not for continuous TBS, bilateral TBS or synchronised TMS. There were no differences in all-cause discontinuation rates. The strongest evidence was for high-frequency rTMS over the left DLPFC. Intermittent TBS provides an advance in terms of reduced treatment duration. tDCS is a potential treatment for non-treatment resistant depression. To date, there is not sufficient published data available to draw firm conclusions about the efficacy and acceptability of TBS and sTMS.

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Effects of transcranial direct current stimulation for treating depression: A modeling study

Effects of transcranial direct current stimulation for treating depression: A modeling study

Article Date: 2018-02-28 (Revised: 2018-12-02)
Authors: Csifcsák G, Boayue NM, Puonti O, Thielscher A, Mittner M
PMID Link: 29529550


Journal Information
Title: Journal of affective disorders
Abbreviation: J Affect Disord
Volume: 234
Issue:
Date: 2018-07-01
Citation: J Affect Disord 2018 07;234:164-173

Abstract

BACKGROUND: Transcranial direct current stimulation (tDCS) above the left dorsolateral prefrontal cortex (lDLPFC) has been widely used to improve symptoms of major depressive disorder (MDD). However, the effects of different stimulation protocols in the entire frontal lobe have not been investigated in a large sample including patient data.

METHODS: We used 38 head models created from structural magnetic resonance imaging data of 19 healthy adults and 19 MDD patients and applied computational modeling to simulate the spatial distribution of tDCS-induced electric fields (EFs) in 20 frontal regions. We evaluated effects of seven bipolar and two multi-electrode 4 × 1 tDCS protocols.

RESULTS: For bipolar montages, EFs were of comparable strength in the lDLPFC and in the medial prefrontal cortex (MPFC). Depending on stimulation parameters, EF cortical maps varied to a considerable degree, but were found to be similar in controls and patients. 4 × 1 montages produced more localized, albeit weaker effects.

LIMITATIONS: White matter anisotropy was not modeled. The relationship between EF strength and clinical response to tDCS could not be evaluated.

CONCLUSIONS: In addition to lDLPFC stimulation, excitability changes in the MPFC should also be considered as a potential mechanism underlying clinical efficacy of bipolar montages. MDD-associated anatomical variations are not likely to substantially influence current flow. Individual modeling of tDCS protocols can substantially improve cortical targeting. We make recommendations for future research to explicitly test the contribution of lDLPFC vs. MPFC stimulation to therapeutic outcomes of tDCS in this disorder.

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