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Clinical pilot study of transcranial direct current stimulation combined with Cognitive Emotional Training for medication resistant depression

Clinical pilot study of transcranial direct current stimulation combined with Cognitive Emotional Training for medication resistant depression

Article Date: 2018-02-17 (Revised: 2018-12-02)
Authors: Martin DM, Teng JZ, Lo TY, Alonzo A, Goh T, Iacoviello BM, Hoch MM, Loo CK
PMID Link: 29477590


Journal Information
Title: Journal of affective disorders
Abbreviation: J Affect Disord
Volume: 232
Issue:
Date: 2018-05-01
Citation: J Affect Disord 2018 05;232:89-95

Abstract

BACKGROUND: While the clinical results from transcranial direct current stimulation (tDCS) for the treatment of depression have been promising, antidepressant effects in patients with medication resistance have been suboptimal. There is therefore a need to further optimise tDCS for medication resistant patients. In this clinical pilot study we examined the feasibility, safety, and clinical efficacy of combining tDCS with a psychological intervention which targets dysfunctional circuitry related to emotion regulation in depression, Cognitive Emotional Training (CET).

METHODS: tDCS was administered during CET three times a week for a total of 18 sessions over 6 weeks. Mood, cognition and emotion processing outcomes were examined at baseline and after 3 and 6 weeks of treatment.

RESULTS: Twenty patients with medication resistant depression participated, of whom 17 were study completers. tDCS combined with CET was found to be feasible, safe, and associated with significant antidepressant efficacy at 6 weeks, with 41% of study completers showing treatment response (≥ 50% improvement in depression score). There were no significant cognitive enhancing effects with the exception of improved emotion recognition. Responders demonstrated superior recognition for the emotions fear and surprise at pre-treatment compared to non-responders, suggesting that better pre-treatment emotion recognition may be associated with antidepressant efficacy.

LIMITATIONS: This was an open label study.

CONCLUSIONS: tDCS combined with CET has potential as a novel method for optimising the antidepressant efficacy of tDCS in medication resistant patients. Future controlled studies are required to determine whether tDCS combined with CET has greater antidepressant efficacy compared to either intervention alone.

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Transcranial direct current stimulation of 20- and 30-minutes combined with sertraline for the treatment of depression

Transcranial direct current stimulation of 20- and 30-minutes combined with sertraline for the treatment of depression

Article Date: 2017-12-09 (Revised: 2019-01-22)
Authors: Pavlova EL, Menshikova AA, Semenov RV, Bocharnikova EN, Gotovtseva GN, Druzhkova TA, Gersamia AG, Gudkova AA, Guekht AB
PMID Link: 29233783


Journal Information
Title: Progress in neuro-psychopharmacology & biological psychiatry
Abbreviation: Prog. Neuropsychopharmacol. Biol. Psychiatry
Volume: 82
Issue:
Date: 2018-03-02
Citation: Prog. Neuropsychopharmacol. Biol. Psychiatry 2018 03;82:31-38

Abstract

BACKGROUND: Transcranial direct current stimulation (tDCS) can be an effective treatment for depression, however, the duration of the stimulation session, among other parameters, needs to be optimized.

METHODS: 69 mild to moderately depressed patients (age 37.6±10.5years, 19 men) were randomized into three groups – 30-, 20-minute or sham tDCS. 10 daily sessions of anodal/sham tDCS of the left DLPFC (0.5mA; electrode 3,5×7cm) combined with 50mg/day of sertraline were performed. Mood, cognition and BDNF level were assessed before and after the treatment.

RESULTS: A significant difference between groups was observed in the percent change of the Hamilton Depression Rating Scale (F(2, 66)=10.1; p<0.001). Sham group (43.4%±18.1) had a smaller improvement compared to the 30-minute (63.8%±13.4; 95% CI: 11.23-29.44; p=0.00003) and 20-minute group (53.2%±15.3; 95% CI: 0.21-19.26; p=0.045). 30-minute group had significantly greater percent improvement than 20-minute group (95% CI: 1.74-19.46; p=0.02). Responders constituted 89%, 68%, and 50% and remitters - 70%, 27%, and 35% in the 30-, 20-minute and sham groups, respectively. A significant difference in the number of responders was observed between 30-minute vs. sham group (odds ratio=8; 95% CI, 2.59-24.69; p=0.001), in remission rate - between 30-minute vs. sham (odds ratio=4.40; 95% CI, 2.02-9.57; p=0.02) and vs. 20-minute (odds ratio=6.33; 95% CI, 2.85-14.10; p=0.003) groups. Two hypomania cases and one case of blood pressure elevation were detected in the 20-minute group. Among neuropsychological tests, only the change in Digit Span Backwards test showed a significant interaction between groups (TIME*GROUP; F(2, 65)=6,6, p=0.002); a greater improvement was observed in both active groups compared to sham (p<0.05). The change in BDNF level after the treatment did not show the significant difference between groups.

CONCLUSIONS: tDCS of 20- or 30-minutes combined with sertraline are efficient for the treatment of mild and moderate depression; the effect of 30min stimulation exceeds the one obtained from 20min.

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Associations between symptoms of depression and heart rate variability: An exploratory study

Associations between symptoms of depression and heart rate variability: An exploratory study

Article Date: 2017-09-12 (Revised: 2018-11-26)
Authors: Borrione L, Brunoni AR, Sampaio-Junior B, Aparicio LM, Kemp AH, Benseñor I, Lotufo PA, Fraguas R
PMID Link: 28958456


Journal Information
Title: Psychiatry research
Abbreviation: Psychiatry Res
Volume: 262
Issue:
Date: 2018-04-01
Citation: Psychiatry Res 2018 04;262:482-487

Abstract

Major depressive disorder (MDD) is associated with decreased heart rate variability (HRV), a predictor of cardiovascular morbidity by many, but not all studies. This inconsistency could be due to the association of HRV with specific depressive symptoms. Here, we investigated the association of HRV parameters with components of depressive symptoms from 120 MDD patients, at baseline of a published trial comparing the effect of sertraline to transcranial direct current stimulation. We used Principal Component Analysis to extract components of the Hamilton Rating Scale for Depression (HAM-D-17), the Montgomery Asberg Depression Rating Scale (MADRS) and the Beck Inventory for Depressive Symptomatology (BDI). We constructed one equation of multiple linear regression for each HRV parameter as the dependent variable, and the components of depressive symptoms of the three scales as the independent ones, adjusted for age and gender. A component of HAM-D-17 predicted LF/HF (low frequency/high frequency) and a component of MADRS predicted LF (low frequency). “Guilt” and “loss of interest/pleasure in activities” were present in the components of both scales, and the MADRS component also included “psychomotor retardation”. These results suggest that melancholic features might be relevant for the association between MDD and HRV. Considering multiple comparisons, these results are preliminary.

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