Tag Archives: Depression

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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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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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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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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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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