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Lima AE, Telles JP, Dantas J, Fernandes AC, Ribeiro GBS, Barbosa VL, Castro-Lima H. Transcranial direct current stimulation improves seizures frequency in drug-resistant epilepsy: A systematic-review and meta-analysis of randomized controlled trials. Epilepsy Behav 2024; 159:109974. [PMID: 39096796 DOI: 10.1016/j.yebeh.2024.109974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 08/05/2024]
Affiliation(s)
- A E Lima
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.
| | - J P Telles
- Department of Neurology, Universidade de São Paulo, São Paulo, Brazil
| | - J Dantas
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - A C Fernandes
- Instituto Internacional de Neurociências Edmond e Lily Safra, Natal, Brazil
| | - G B S Ribeiro
- Department of Neurology, Universidade de Campinas, Campinas, Brazil
| | - V L Barbosa
- Universidade Estadual do Centro Oeste do Paraná, Guarapuava, Brazil
| | - H Castro-Lima
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
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Li D, Liu R, Ye F, Li R, Li X, Liu J, Zhang X, Zhou J, Wang G. Modulation of brain function and antidepressant effects by transcranial alternating current stimulation in patients with major depressive disorder: Evidence from ERP. J Psychiatr Res 2024; 176:1-8. [PMID: 38824877 DOI: 10.1016/j.jpsychires.2024.05.045] [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: 03/04/2024] [Revised: 04/30/2024] [Accepted: 05/29/2024] [Indexed: 06/04/2024]
Abstract
Transcranial alternating current stimulation (tACS) is an emerging non-invasive neuromodulation treatment for major depressive disorder (MDD), but its mechanism remains unclear. Therefore, we evaluated the effects of tACS on event-related potentials (ERP) based on a randomized controlled study. All patients were divided into two groups to receive either 20 sessions 77.5Hz-tACS or 20 sessions of sham stimulation during 4 weeks. The Hamilton Depression Rating Scale for Depression -17 item (HAMD-17) and ERP during face-word Stroop task were recorded before and after the treatment (the fourth weekend). Our findings indicate a significant alleviation of depressive symptoms after tACS. For the behavioral performance, sham group showed a significant decrease in reaction time to the sad incongruent condition and an increase in accuracy to the happy condition. The active group showed an increase in accuracy to the incongruent condition. ERP analysis revealed that tACS significantly shortened the latency of P2 to incongruent condition, decreased the amplitude and prolonged the latency of N2 to negative condition. These ERP alterations suggest a potential rectification of negative bias and enhancement of cognitive functioning in patients with MDD, offering insights into the antidepressant mechanisms of tACS.
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Affiliation(s)
- Dan Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Rui Liu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Fukang Ye
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Ruinan Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xiaoya Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jing Liu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xueshan Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jingjing Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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Lotfaliany M, Agustini B, Walker AJ, Turner A, Wrobel AL, Williams LJ, Dean OM, Miles S, Rossell SL, Berk M, Mohebbi M. Development of a harmonized sociodemographic and clinical questionnaire for mental health research: A Delphi-method-based consensus recommendation. Aust N Z J Psychiatry 2024; 58:656-667. [PMID: 38845137 PMCID: PMC11308274 DOI: 10.1177/00048674241253452] [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] [Indexed: 08/07/2024]
Abstract
OBJECTIVE Harmonized tools are essential for reliable data sharing and accurate identification of relevant factors in mental health research. The primary objective of this study was to create a harmonized questionnaire to collect demographic, clinical and behavioral data in diverse clinical trials in adult psychiatry. METHODS We conducted a literature review and examined 24 questionnaires used in previously published randomized controlled trials in psychiatry, identifying a total of 27 domains previously explored. Using a Delphi-method process, a task force team comprising experts in psychiatry, epidemiology and statistics selected 15 essential domains for inclusion in the final questionnaire. RESULTS The final selection resulted in a concise set of 22 questions. These questions cover factors such as age, sex, gender, ancestry, education, living arrangement, employment status, home location, relationship status, and history of medical and mental illness. Behavioral factors like physical activity, diet, smoking, alcohol and illicit drug use were also included, along with one question addressing family history of mental illness. Income was excluded due to high confounding and redundancy, while language was included as a measure of migration status. CONCLUSION The recommendation and adoption of this harmonized tool for the assessment of demographic, clinical and behavioral data in mental health research can enhance data consistency and enable comparability across clinical trials.
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Affiliation(s)
- Mojtaba Lotfaliany
- Deakin University, School of Medicine, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Bruno Agustini
- Deakin University, School of Medicine, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Adam J Walker
- Deakin University, School of Medicine, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Alyna Turner
- Deakin University, School of Medicine, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Anna L Wrobel
- Deakin University, School of Medicine, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Lana J Williams
- Deakin University, School of Medicine, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Olivia M Dean
- Deakin University, School of Medicine, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
- Florey Institute for Neuroscience & Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Miles
- Orygen, Parkville, VIC, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
- Psychiatry, St Vincent’s Hospital, Melbourne, VIC, Australia
| | - Michael Berk
- Deakin University, School of Medicine, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
- Florey Institute for Neuroscience & Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Orygen, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, VIC, Australia
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Zheng EZ, Wong NML, Yang ASY, Lee TMC. Evaluating the effects of tDCS on depressive and anxiety symptoms from a transdiagnostic perspective: a systematic review and meta-analysis of randomized controlled trials. Transl Psychiatry 2024; 14:295. [PMID: 39025832 PMCID: PMC11258305 DOI: 10.1038/s41398-024-03003-w] [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: 11/28/2023] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024] Open
Abstract
Depressive and anxiety symptoms are prevalent among patients with various clinical conditions, resulting in diminished emotional well-being and impaired daily functioning. The neural mechanisms underlying these symptoms, particularly across different disorders, remain unclear, limiting the effectiveness of conventional treatments. Therefore, it is crucial to elucidate the neural underpinnings of depressive and anxiety symptoms and investigate novel, effective treatments across clinical conditions. Transcranial direct current stimulation (tDCS) is a neuromodulatory technique that can help understand the neural underpinnings of symptoms and facilitate the development of interventions, addressing the two research gaps at both neural and clinical levels. Thus, this systematic review and meta-analysis aims to evaluate the existing evidence regarding the therapeutic efficacy of tDCS in reducing depressive and anxiety symptoms among individuals with diverse clinical diagnoses. This review evaluated evidence from fifty-six randomized, sham-controlled trials that administered repeated tDCS sessions with a parallel design, applying a three-level meta-analytic model. tDCS targeting the left dorsolateral prefrontal cortex (DLPFC) at 2-mA intensity demonstrates moderate efficacy in alleviating depressive symptoms, identifying the left DLPFC as a transdiagnostic neural mechanism of depressive symptoms across clinical conditions. In comparison, the findings on anxiety symptoms demonstrate greater heterogeneity. tDCS over the left DLPFC is effective in reducing depressive symptoms and shows promising effects in alleviating anxiety symptoms among individuals with diverse diagnoses. These findings enhance our understanding of the neuropsychological basis of depressive and anxiety symptoms, laying the groundwork for the development of more effective tDCS interventions applicable across clinical conditions.
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Affiliation(s)
- Esther Zhiwei Zheng
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Nichol M L Wong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong.
- Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Pok Fu Lam, Hong Kong.
- Department of Psychology, The Education University of Hong Kong, Ting Kok, Hong Kong.
| | - Angela S Y Yang
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Tatia M C Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong.
- Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Pok Fu Lam, Hong Kong.
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5
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Dehghani A, Bango C, Murphy EK, Halter RJ, Wager TD. Independent effects of transcranial direct current stimulation and social influence on pain. Pain 2024:00006396-990000000-00657. [PMID: 39167466 DOI: 10.1097/j.pain.0000000000003338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/28/2024] [Indexed: 08/23/2024]
Abstract
ABSTRACT Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulatory technique with the potential to provide pain relief. However, tDCS effects on pain are variable across existing studies, possibly related to differences in stimulation protocols and expectancy effects. We investigated the independent and joint effects of contralateral motor cortex tDCS (anodal vs cathodal) and socially induced expectations (analgesia vs hyperalgesia) about tDCS on thermal pain. We employed a double-blind, randomized 2 × 2 factorial cross-over design, with 5 sessions per participant on separate days. After calibration in Session 1, Sessions 2 to 5 crossed anodal or cathodal tDCS (20 minutes 2 mA) with socially induced analgesic or hyperalgesic expectations, with 6 to 7 days between the sessions. The social manipulation involved videos of previous "participants" (confederates) describing tDCS as inducing a low-pain state ("analgesic expectancy") or hypersensitivity to sensation ("hyperalgesic expectancy"). Anodal tDCS reduced pain compared with cathodal stimulation (F(1,19.9) = 19.53, P < 0.001, Cohen d = 0.86) and analgesic expectancy reduced pain compared with hyperalgesic expectancy (F(1,19.8) = 5.62, P = 0.027, Cohen d = 0.56). There was no significant interaction between tDCS and social expectations. Effects of social suggestions were related to expectations, whereas tDCS effects were unrelated to expectancies. The observed additive effects provide novel evidence that tDCS and socially induced expectations operate through independent processes. They extend clinical tDCS studies by showing tDCS effects on controlled nociceptive pain independent of expectancy effects. In addition, they show that social suggestions about neurostimulation effects can elicit potent placebo effects.
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Affiliation(s)
- Amin Dehghani
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Carmen Bango
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Ethan K Murphy
- Thayer School of Engineering and Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Ryan J Halter
- Thayer School of Engineering and Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
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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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Sabé M, Hyde J, Cramer C, Eberhard A, Crippa A, Brunoni AR, Aleman A, Kaiser S, Baldwin DS, Garner M, Sentissi O, Fiedorowicz JG, Brandt V, Cortese S, Solmi M. Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders: A Systematic Review and Dose-Response Meta-Analysis. JAMA Netw Open 2024; 7:e2412616. [PMID: 38776083 PMCID: PMC11112448 DOI: 10.1001/jamanetworkopen.2024.12616] [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: 01/03/2024] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Noninvasive brain stimulation (NIBS) interventions have been shown to be efficacious in several mental disorders, but the optimal dose stimulation parameters for each disorder are unknown. Objective To define NIBS dose stimulation parameters associated with the greatest efficacy in symptom improvement across mental disorders. Data Sources Studies were drawn from an updated (to April 30, 2023) previous systematic review based on a search of PubMed, OVID, and Web of Knowledge. Study Selection Randomized clinical trials were selected that tested transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) for any mental disorder in adults aged 18 years or older. Data Extraction and Synthesis Two authors independently extracted the data. A 1-stage dose-response meta-analysis using a random-effects model was performed. Sensitivity analyses were conducted to test robustness of the findings. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures The main outcome was the near-maximal effective doses of total pulses received for TMS and total current dose in coulombs for tDCS. Results A total of 110 studies with 4820 participants (2659 men [61.4%]; mean [SD] age, 42.3 [8.8] years) were included. The following significant dose-response associations emerged with bell-shaped curves: (1) in schizophrenia, high-frequency (HF) TMS on the left dorsolateral prefrontal cortex (LDLPFC) for negative symptoms (χ2 = 9.35; df = 2; P = .009) and TMS on the left temporoparietal junction for resistant hallucinations (χ2 = 36.52; df = 2; P < .001); (2) in depression, HF-DLPFC TMS (χ2 = 14.49; df = 2; P < .001); (3) in treatment-resistant depression, LDLPFC tDCS (χ2 = 14.56; df = 2; P < .001); and (4) in substance use disorder, LDLPFC tDCS (χ2 = 33.63; df = 2; P < .001). The following significant dose-response associations emerged with plateaued or ascending curves: (1) in depression, low-frequency (LF) TMS on the right DLPFC (RDLPFC) with ascending curve (χ2 = 25.67; df = 2; P = .001); (2) for treatment-resistant depression, LF TMS on the bilateral DLPFC with ascending curve (χ2 = 5.86; df = 2; P = .004); (3) in obsessive-compulsive disorder, LF-RDLPFC TMS with ascending curve (χ2 = 20.65; df = 2; P < .001) and LF TMS on the orbitofrontal cortex with a plateaued curve (χ2 = 15.19; df = 2; P < .001); and (4) in posttraumatic stress disorder, LF-RDLPFC TMS with ascending curve (χ2 = 54.15; df = 2; P < .001). Sensitivity analyses confirmed the main findings. Conclusions and Relevance The study findings suggest that NIBS yields specific outcomes based on dose parameters across various mental disorders and brain regions. Clinicians should consider these dose parameters when prescribing NIBS. Additional research is needed to prospectively validate the findings in randomized, sham-controlled trials and explore how other parameters contribute to the observed dose-response association.
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Affiliation(s)
- Michel Sabé
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Joshua Hyde
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
| | - Catharina Cramer
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Antonia Eberhard
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Alessio Crippa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - André Russowsky Brunoni
- Departamento e Instituto de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, Brazil
| | - André Aleman
- Department of Biomedical Sciences of Cells and Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
| | - David S. Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom
- University Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Matthew Garner
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ontario, Canada
| | - Othman Sentissi
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jess G. Fiedorowicz
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ontario, Canada
- Department of Psychiatry, University of Ottawa, Ontario, Canada
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, United Kingdom
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, United Kingdom
- Hassenfeld Children’s Hospital at New York University Langone, New York University Child Study Center, New York, New York
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, United Kingdom
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Marco Solmi
- The Ottawa Hospital and Ottawa Hospital Research Institute, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada
- SIENCES Laboratory, Department of Psychiatry, University of Ottawa, Ontario, Canada
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Kochanowski B, Kageki-Bonnert K, Pinkerton EA, Dougherty DD, Chou T. A Review of Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Combined with Medication and Psychotherapy for Depression. Harv Rev Psychiatry 2024; 32:77-95. [PMID: 38728568 DOI: 10.1097/hrp.0000000000000396] [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: 05/12/2024]
Abstract
LEARNING OBJECTIVES After participating in this CME activity, the psychiatrist should be better able to:• Compare and contrast therapies used in combination with transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) for treating MDD. BACKGROUND Noninvasive neuromodulation, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), has emerged as a major area for treating major depressive disorder (MDD). This review has two primary aims: (1) to review the current literature on combining TMS and tDCS with other therapies, such as psychotherapy and psychopharmacological interventions, and (2) to discuss the efficacy, feasibility, limitations, and future directions of these combined treatments for MDD. METHOD This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched three databases: PubMed, PsycInfo, and Cochrane Library. The last search date was December 5, 2023. RESULTS The initial search revealed 2,519 records. After screening and full-text review, 58 studies (7 TMS plus psychotherapy, 32 TMS plus medication, 7 tDCS plus psychotherapy, 12 tDCS plus medication) were included. CONCLUSIONS The current literature on tDCS and TMS paired with psychotherapy provides initial support for integrating mindfulness interventions with both TMS and tDCS. Adding TMS or tDCS to stable doses of ongoing medications can decrease MDD symptoms; however, benzodiazepines may interfere with TMS and tDCS response, and antipsychotics can interfere with TMS response. Pairing citalopram with TMS and sertraline with tDCS can lead to greater MDD symptom reduction compared to using these medications alone. Future studies need to enroll larger samples, include randomized controlled study designs, create more uniform protocols for combined treatment delivery, and explore mechanisms and predictors of change.
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Affiliation(s)
- Brian Kochanowski
- From Harvard Medical School, Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
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Kong S, Chen Y, Huang H, Yang W, Lyu D, Wang F, Huang Q, Zhang M, Chen S, Wei Z, Shi S, Fang Y, Hong W. Efficacy of transcranial direct current stimulation for treating anhedonia in patients with depression: A randomized, double-blind, sham-controlled clinical trial. J Affect Disord 2024; 350:264-273. [PMID: 38232776 DOI: 10.1016/j.jad.2024.01.041] [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: 10/30/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Anhedonia, the core symptom of major depressive disorder (MDD), is highly prevalent in patients with depression. Anhedonia is associated with low efficacy of drug treatment, high suicide rates, and poor social function. Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technology that uses constant, low-intensity direct current to treat MDD by regulating cortical activity and neuronal excitability. However, little is known about the efficacy of tDCS for treating anhedonia in patients with depression, and even the existing results of clinical trials are conflicting. In addition, there is no consensus on what brain regions should be targeted by tDCS during the treatment of anhedonia in patients with depression. OBJECTIVE This study aimed to evaluate the efficacy and safety of tDCS over the left dorsolateral prefrontal cortex (DLPFC) and right orbitofrontal cortex (OFC) in the improvement of anhedonia in patients with depression and finally identified suitable brain regions to be stimulated during treatment. METHODS This randomized, double-blind, sham-controlled clinical trial recruited 70 patients with anhedonia and depressive episodes. Patients were randomly assigned to three groups according to the stimulation site: right orbitofrontal cortex (OFC), left dorsolateral prefrontal cortex (DLPFC), and sham stimulation. Each group received twelve 20-min interventions (ten as primary treatment and two for consolidation). The primary outcome was a decrease in Snaith-Hamilton Pleasure Scale (SHAPS) scores after primary treatment. Evaluations were performed at baseline, post-treatment, and 8-week follow-up. RESULTS The depression mood of the three groups of patients at each time point was better than the baseline, but there was no significant difference in the efficacy between the groups (p>0.05). On the basis of the improvement of depression, this study found that tDCS of the DLPFC significantly improved anhedonia (p = 0.028) after primary treatment (2 weeks), and tDCS of the DLPFC and OFC significantly improved social functioning (p = 0.005) at 8-week follow-up. LIMITATIONS The sample size of this study was small, with only about 23/24 patients in each group completing the intervention assessments; due to the impact of the COVID-19 epidemic, data analysis was limited by the lack of patients during the follow-up period. CONCLUSIONS tDCS of the DLPFC significantly improves anhedonia in depressed patients and is thus a potential adjuvant therapy for anhedonia in these patients.
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Affiliation(s)
- Shuqi Kong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijing Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shenzhen Institute of Advanced Technology, Chinese academy of Science, Shenzhen, China
| | - Weichieh Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongbin Lyu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinte Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengke Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shentse Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheyi Wei
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuxiang Shi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiru Fang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China.
| | - Wu Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China.
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10
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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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Lewis A, Toufexis C, Goldsmith C, Robinson R, Howie G, Rattray B, Flood A. The Effects of Transcranial Direct Current Stimulation and Exercise on Salivary S100B Protein Indicated Blood-Brain Barrier Permeability: A Pilot Study. Neuromodulation 2023:S1094-7159(23)00984-4. [PMID: 38159099 DOI: 10.1016/j.neurom.2023.11.006] [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: 08/27/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study aimed to assess the effect of transcranial direct current stimulation (tDCS) and exercise on blood-brain barrier (BBB) permeability in humans as assessed through the quantification of the salivary protein biomarker S100B. It was hypothesized that active tDCS would induce a significant increase in salivary S100B concentration when compared with sham stimulation and no stimulation. It also was hypothesized that the increase in salivary S100B concentration would be greater after active tDCS and exercise than after tDCS or exercise alone. MATERIALS AND METHODS A total of 13 healthy adults (five male, eight female), ranging in age from 21 to 32 years, underwent three experimental conditions (active tDCS, sham tDCS, inactive control). To assess exercise- and tDCS-induced changes in BBB permeability, S100B in saliva was measured. Saliva samples were taken before tDCS, after tDCS, and immediately after a ramped cycling time-to-exhaustion (TTE) task. Active tDCS involved the application of anodal stimulation over the primary motor cortex for 20 minutes at 2 mA. RESULTS S100B concentrations in the control condition did not differ significantly from the active condition (estimate = 0.10, SE = 0.36, t = 0.27, p = 0.79) or the sham condition (estimate = 0.33, SE = 0.36, t = 0.89, p = 0.38). Similarly, S100B concentrations at baseline did not differ significantly from post-intervention (estimate = -0.35, SE = 0.34, t = -1.03, p = 0.31) or post-TTE (estimate = 0.66, SE = 0.34, t = 1.93, p = 0.06). CONCLUSIONS This research provides novel insight into the effect of tDCS and exercise on S100B-indicated BBB permeability in humans. Although the effects of tDCS were not significant, increases in salivary S100B after a fatiguing cycling task may indicate exercise-induced changes in BBB permeability.
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Affiliation(s)
- Aidan Lewis
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia; University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia.
| | - Constantino Toufexis
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Chloe Goldsmith
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Rebecca Robinson
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Grace Howie
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Ben Rattray
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Andrew Flood
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia; University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia
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12
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Han YM, Chan MM, Shea CK, Mo FY, Yiu KW, Chung RC, Cheung MC, Chan AS. Effects of prefrontal transcranial direct current stimulation on social functioning in autism spectrum disorder: A randomized clinical trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2465-2482. [PMID: 37151094 DOI: 10.1177/13623613231169547] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
LAY ABSTRACT Currently available pharmacological and behavioral interventions for adolescents and young adults with autism spectrum disorder (ASD) yield only modest effect in alleviating their core behavioral and cognitive symptoms, and some of these treatment options are associated with undesirable side effects. Hence, developing effective treatment protocols is urgently needed. Given emerging evidence shows that the abnormal connections of the frontal brain regions contribute to the manifestations of ASD behavioral and cognitive impairments, noninvasive treatment modalities that are capable in modulating brain connections, such as transcranial direct current stimulation (tDCS), have been postulated to be potentially promising for alleviating core symptoms in ASD. However, whether tDCS can reduce behavioral symptoms and enhance cognitive performance in ASD remains unclear. This randomized controlled trial involving 105 adolescents and young adults with ASD showed that multiple sessions of a tDCS protocol, which was paired up with computerized cognitive training, was effective in improving social functioning in adolescents and young adults with ASD. No prolonged and serious side effects were observed. With more future studies conducted in different clinical settings that recruit participants from a wider age range, this tDCS protocol may be potentially beneficial to a broad spectrum of individuals with autism.
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Affiliation(s)
| | - Melody My Chan
- The Hong Kong Polytechnic University, Hong Kong
- The University of Queensland, Australia
| | - Caroline Ks Shea
- Hospital Authority, Hong Kong
- The Chinese University of Hong Kong, Hong Kong
| | - Flora Ym Mo
- Hospital Authority, Hong Kong
- The Chinese University of Hong Kong, Hong Kong
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13
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Wang TW, Gong J, Wang Y, Liang Z, Pang KL, Wang JS, Zhang ZG, Zhang CY, Zhou Y, Li JC, Wang YN, Zhou YJ. Differences in Non-suicidal Self-injury Behaviors between Unipolar Depression and Bipolar Depression in Adolescent Outpatients. Curr Med Sci 2023; 43:998-1004. [PMID: 37558867 DOI: 10.1007/s11596-023-2772-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: 04/26/2022] [Accepted: 05/24/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) has a higher prevalence in adolescents with depressive disorders than in community adolescents. This study examined the differences in NSSI behaviors between adolescents with unipolar depression (UD) and those with bipolar depression (BD). METHODS Adolescents with UD or BD were recruited from 20 general or psychiatric hospitals across China. The methods, frequency, and function of NSSI were assessed by Functional Assessment of Self-Mutilation. The Beck Suicide Ideation Scale was used to evaluate adolescents' suicidal ideation, and the 10-item Kessler Psychological Distress Scale to estimate the anxiety and depression symptoms. RESULTS The UD group had higher levels of depression (19.16 vs.17.37, F=15.23, P<0.001) and anxiety symptoms (17.73 vs.16.70, F=5.00, P=0.026) than the BD group. Adolescents with BD had a longer course of NSSI than those with UD (2.00 vs.1.00 year, Z=-3.39, P=0.001). There were no statistical differences in the frequency and the number of methods of NSSI between the UD and BD groups. Depression (r=0.408, P<0.01) and anxiety (r=0.391, P<0.01) were significantly and positively related to NSSI frequency. CONCLUSION Adolescents with BD had a longer course of NSSI than those with UD. More importantly, NSSI frequency were positively and strongly correlated with depression and anxiety symptoms, indicating the importance of adequate treatment of depression and anxiety in preventing and intervening adolescents' NSSI behaviors.
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Affiliation(s)
- Ting-Wei Wang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China
| | - Jian Gong
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Yang Wang
- College of Management, Shenzhen University, Shenzhen, 518000, China
| | - Zhen Liang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518000, China
| | - Ke-Liang Pang
- School of Pharmaceutical Sciences, IDG/McGovern Institute for Brain Research, Tsinghua University-Peking University Joint Center for Life Sciences, Tsinghua University, Beijing, 100000, China
| | - Jie-Si Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100000, China
| | - Zhi-Guo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518000, China
| | - Chun-Yan Zhang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China
| | - Yue Zhou
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Jun-Chang Li
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China
| | - Yan-Ni Wang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China.
| | - Yong-Jie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, 518000, China.
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14
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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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15
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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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16
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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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17
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Zhang L, Li Q, Du Y, Gao Y, Bai T, Ji GJ, Tian Y, Wang K. Effect of high-definition transcranial direct current stimulation on improving depression and modulating functional activity in emotion-related cortical-subcortical regions in bipolar depression. J Affect Disord 2023; 323:570-580. [PMID: 36503046 DOI: 10.1016/j.jad.2022.12.007] [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: 08/31/2022] [Revised: 11/09/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
Preliminary studies have suggested that transcranial direct current stimulation (tDCS) is effective for bipolar depression, However, brain correlates of the depression alleviating are unclear. To determine the efficacy and safety of tDCS as an add-on treatment for patients with bipolar depression and further to identify the effect of tDCS on the resting-state brain activities, we recruited fifty patients with bipolar depression to complete the double-blind, sham-controlled and randomized clinical trial. Fourteen sessions of tDCS were performed once a day for 14 days. The anode was placed over F3 with return electrodes placed at FP1, FZ, C3 and F7. Regional homogeneity (ReHo) was examined on 50 patients with bipolar depression before and after 14-day active or sham tDCS. Patients in the active group showed significantly superior alleviating the depression symptoms compared with those receiving sham. The active group after 14-day active tDCS showed increased ReHo values in the orbitofrontal cortex and middle frontal gyrus and decreased ReHo values in subcortical structures including hippocampus, parahippocampa gyrus, amygdala, putamen and lentiform nucleus. The reduction of depression severity showed positive correlation of increased ReHo values in the orbitofrontal cortex and middle frontal gyrus and negative correlation of altered ReHo values in the putamen and lentiform. TDCS was an effective and safe add-on intervention for this small bipolar depression sample. The reduction of depression induced by tDCS is associated with a modulation of neural synchronization in the cortical and subcortical structures (ReHo values) within an emotion-related brain network.
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Affiliation(s)
- Li Zhang
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui Province, China; Anhui Mental Health Center, Hefei, Anhui Province, China; Brain Disorders and Neuromodulation Research Centre, Anhui Mental Health Center, Hefei, Anhui Province, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China
| | - Qun Li
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui Province, China; Anhui Mental Health Center, Hefei, Anhui Province, China; Brain Disorders and Neuromodulation Research Centre, Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Yuan Du
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui Province, China; Anhui Mental Health Center, Hefei, Anhui Province, China; Brain Disorders and Neuromodulation Research Centre, Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Yue Gao
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, Anhui Province, China; Anhui Mental Health Center, Hefei, Anhui Province, China; Brain Disorders and Neuromodulation Research Centre, Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Tongjian Bai
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China; Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230022, China
| | - Gong-Jun Ji
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230022, China; Department of Medical Psychology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yanghua Tian
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China; Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230022, China; Department of Neurology, First Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui Province, China.
| | - Kai Wang
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China; Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230022, China; Department of Medical Psychology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Department of Neurology, First Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui Province, China.
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18
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Ashrafzadeh F, Akhondian J, Hashemi N, Esmaeilzadeh M, Ghanaee A, Yavarzadeh H, Imannezhad S, Saeedi Zand N, Mirzadeh HS, Beiraghi Toosi M. Therapeutical impacts of transcranial direct current stimulation on drug-resistant epilepsy in pediatric patients: A double-blind parallel-group randomized clinical trial. Epilepsy Res 2023; 190:107074. [PMID: 36657251 DOI: 10.1016/j.eplepsyres.2022.107074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 08/14/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Drug-resistant epilepsy is a challenging problem in pediatrics. Transcranial direct current stimulation (TDCS) is a non-invasive neurostimulation technique suggested as a promising method for treating epilepsy. This study aims to evaluate the efficacy of TDCS in focal epilepsy in children with drug-resistant epilepsy. METHOD We conducted a randomized sham-controlled study with 18 subjects between 6 and 16 years of age, divided equally into two groups. TDCS was performed in 20-minute daily stimulation protocol for five days for both groups. The current intensity was one mA for the first three days, increasing to 1.5 mA on day four and 2 mA on the last day of stimulation. EEG was done before and after the intervention. RESULTS There was a significant reduction in seizure duration in the case group compared with the sham group. CONCLUSION five consecutive days of performing TDCS significantly reduced seizure duration in children with focal Drug-resistant epilepsy. However,further studies in this field are necessary to test the effectiveness and set up a coherent and comprehensive protocol.
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Affiliation(s)
- Farah Ashrafzadeh
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Akhondian
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Hashemi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Esmaeilzadeh
- Student Research Committee (SRC), Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Ghanaee
- Department of Psychology, Faculty of Education and Psychology, Ferdowsi University, Mashhad, Iran
| | - Hanieh Yavarzadeh
- MA Student of Psychology, Faculty of Education and Psychology, Ferdowsi University, Mashhad, Iran
| | - Shima Imannezhad
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nazanin Saeedi Zand
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hanieh Sadat Mirzadeh
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehran Beiraghi Toosi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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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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20
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Deng X, Zhang H. Mental health status among non-medical college students returning to school during the COVID-19 pandemic in Zhanjiang city: A cross-sectional study. Front Psychol 2023; 13:1035458. [PMID: 36710795 PMCID: PMC9874120 DOI: 10.3389/fpsyg.2022.1035458] [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: 09/02/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has brought huge and continuous damage to mental health. The mental health of non-medical college students after returning to school remains largely unknown and the influencing factors were awaited to be deciphered. This cross-sectional study was launched among 1,083 non-medical students in Zhanjiang city by means of online survey (WeChat App) from August 1st, 2022 to August 7th, 2022. Knowledge about COVID-19 and attitude toward COVID-19 were assessed by using 7-items and 5-items questionnaires, respectively. Sleep quality, anxiety and depression symptoms were evaluated by Pittsburgh sleep quality index (PSQI), Hamilton depression rating scale-17 (HDRS-17) and self-rating anxiety scale (SAS), respectively. The results showed that more than half of the participants were knowledgeable about COVID-19. The majority of the participants held positive attitude toward COVID-19. The data demonstrated that 6.8% students had poor sleep quality, and 1.86, 0.37 and 0.37% students had mild, moderate and severe anxiety, respectively. About 26.7, 4.7 and 1.7% students had minimal, mild-moderate and severe depression. Female students showed higher proportions of anxiety (p = 0.02) and depression (p < 0.0001) than male students. Students with monthly household income below 3,000 RMB were more vulnerable to anxiety (p = 0.017) and depression (p = 0.004). Correlation analysis and Multivariate logistic regression analysis results showed that lower grade was positively related with anxiety and depression. Female students, income lower than 3,000 RMB/month, poor knowledge about COVID-19 and negative attitude toward COVID-19 were associated with insomnia, anxiety and depression. This study indicated that during the COVID-19 pandemic, a majority of non-medical students returning to school remained good sleep quality and a small number of students suffered from depression and anxiety. To our knowledge, this is a novel study revealing the mental health of non-medical college students concerning COVID-19 in Zhanjiang.
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Affiliation(s)
- Xiaojun Deng
- Department of Preschool Education, Zhanjiang Preschool Education College, Zhanjiang, China
| | - Huiting Zhang
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China,*Correspondence: Huiting Zhang,
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21
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Wandrey JD, Kastelik J, Fritzsche T, Denke C, Schäfer M, Tafelski S. Supplementing transcranial direct current stimulation to local infiltration series for refractory neuropathic craniocephalic pain: A randomized controlled pilot trial. Front Neurol 2023; 14:1069434. [PMID: 36937523 PMCID: PMC10014889 DOI: 10.3389/fneur.2023.1069434] [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: 10/13/2022] [Accepted: 02/07/2023] [Indexed: 03/05/2023] Open
Abstract
Background Some patients with neuralgia of cranial nerves with otherwise therapy-refractory pain respond to invasive therapy with local anesthetics. Unfortunately, pain regularly relapses despite multimodal pain management. Transcranial direct current stimulation (tDCS) may prolong pain response due to neuro-modulatory effects. Methods This controlled clinical pilot trial randomized patients to receive anodal, cathodal or sham-tDCS stimulation prior to local anesthetic infiltration. Pain attenuation, quality-of-life and side effects were assessed and compared with historic controls to estimate effects of tDCS stimulation setting. Results Altogether, 17 patients were randomized into three groups with different stimulation protocols. Relative reduction of pain intensity in per protocol treated patients were median 73%, 50% and 69% in anodal, cathodal and sham group, respectively (p = 0.726). Compared with a historic control group, a lower rate of responders with 50% reduction of pain intensity indicates probable placebo effects (OR 3.41 stimulation vs. non-stimulation setting, NNT 3.63). 76.9% (n = 10) of tDCS patients reported mild side-effects. Of all initially included 17 patients, 23.5% (n = 4) withdrew their study participation with highest proportion in the cathodal group (n = 3). A sample size calculation for a confirmatory trial revealed 120 patients using conservative estimations. Discussion This pilot trial does not support series of anodal tDCS as neuro-modulatory treatment to enhance pain alleviation of local anesthetic infiltration series. Notably, results may indicate placebo effects of tDCS settings. Feasibility of studies in this population was limited due to relevant drop-out rates. Anodal tDCS warrants further confirmation as neuro-modulatory pain treatment option.
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22
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Gersten M, Jamil A, Cassano P, Camprodon JA. Transcranial Direct Current Stimulation (tDCS) for Major Depressive Disorder. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20221025-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Chang TT, Chang YH, Du SH, Chen PJ, Wang XQ. Non-invasive brain neuromodulation techniques for chronic low back pain. Front Mol Neurosci 2022; 15:1032617. [PMID: 36340685 PMCID: PMC9627199 DOI: 10.3389/fnmol.2022.1032617] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/03/2022] [Indexed: 11/22/2022] Open
Abstract
Structural and functional changes of the brain occur in many chronic pain conditions, including chronic low back pain (CLBP), and these brain abnormalities can be reversed by effective treatment. Research on the clinical applications of non-invasive brain neuromodulation (NIBS) techniques for chronic pain is increasing. Unfortunately, little is known about the effectiveness of NIBS on CLBP, which limits its application in clinical pain management. Therefore, we summarized the effectiveness and limitations of NIBS techniques on CLBP management and described the effects and mechanisms of NIBS approaches on CLBP in this review. Overall, NIBS may be effective for the treatment of CLBP. And the analgesic mechanisms of NIBS for CLBP may involve the regulation of pain signal pathway, synaptic plasticity, neuroprotective effect, neuroinflammation modulation, and variations in cerebral blood flow and metabolism. Current NIBS studies for CLBP have limitations, such as small sample size, relative low quality of evidence, and lack of mechanistic studies. Further studies on the effect of NIBS are needed, especially randomized controlled trials with high quality and large sample size.
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Affiliation(s)
- Tian-Tian Chang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yu-Hao Chang
- Department of Luoyang Postgraduate Training, Henan University of Traditional Chinese Medicine, Luoyang, China
| | - Shu-Hao Du
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Pei-Jie Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- *Correspondence: Pei-Jie Chen,
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
- Shanghai Key Lab of Human Performance, Shanghai University of Sport, Shanghai, China
- Xue-Qiang Wang,
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24
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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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25
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Lu J, Zhang Z, Yin X, Tang Y, Ji R, Chen H, Guang Y, Gong X, He Y, Zhou W, Wang H, Cheng K, Wang Y, Chen X, Xie P, Guo ZV. An entorhinal-visual cortical circuit regulates depression-like behaviors. Mol Psychiatry 2022; 27:3807-3820. [PMID: 35388184 DOI: 10.1038/s41380-022-01540-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 02/28/2022] [Accepted: 03/21/2022] [Indexed: 02/08/2023]
Abstract
Major depressive disorder is viewed as a 'circuitopathy'. The hippocampal-entorhinal network plays a pivotal role in regulation of depression, and its main sensory output, the visual cortex, is a promising target for stimulation therapy of depression. However, whether the entorhinal-visual cortical pathway mediates depression and the potential mechanism remains unknown. Here we report a cortical circuit linking entorhinal cortex layer Va neurons to the medial portion of secondary visual cortex (Ent→V2M) that bidirectionally regulates depression-like behaviors in mice. Analyses of brain-wide projections of Ent Va neurons and two-color retrograde tracing indicated that Ent Va→V2M projection neurons represented a unique population of neurons in Ent Va. Immunostaining of c-Fos revealed that activity in Ent Va neurons was decreased in mice under chronic social defeat stress (CSDS). Both chemogenetic inactivation of Ent→V2M projection neurons and optogenetic inactivation of the projection terminals induced social deficiency, anxiety- and despair-related behaviors in healthy mice. Chemogenetic inactivation of Ent→V2M projection neurons also aggravated these depression-like behaviors in CSDS-resilient mice. Optogenetic activation of Ent→V2M projection terminals rapidly ameliorated depression-like phenotypes. Optical recording using fiber photometry indicated that elevated neural activity in Ent→V2M projection terminals promoted antidepressant-like behaviors. Thus, the Ent→V2M circuit plays a crucial role in regulation of depression-like behaviors, and can function as a potential target for treating major depressive disorder.
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Affiliation(s)
- Jian Lu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases & Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 400016, Chongqing, China.,IDG/McGovern Institute for Brain Research, School of Medicine, Tsinghua University, 100084, Beijing, China.,Tsinghua-Peking Center for Life Sciences, 100084, Beijing, China
| | - Zhouzhou Zhang
- IDG/McGovern Institute for Brain Research, School of Medicine, Tsinghua University, 100084, Beijing, China.,Tsinghua-Peking Center for Life Sciences, 100084, Beijing, China
| | - Xinxin Yin
- IDG/McGovern Institute for Brain Research, School of Medicine, Tsinghua University, 100084, Beijing, China.,Tsinghua-Peking Center for Life Sciences, 100084, Beijing, China
| | - Yingjun Tang
- IDG/McGovern Institute for Brain Research, School of Medicine, Tsinghua University, 100084, Beijing, China.,Tsinghua-Peking Center for Life Sciences, 100084, Beijing, China
| | - Runan Ji
- IDG/McGovern Institute for Brain Research, School of Medicine, Tsinghua University, 100084, Beijing, China.,Tsinghua-Peking Center for Life Sciences, 100084, Beijing, China
| | - Han Chen
- IDG/McGovern Institute for Brain Research, School of Medicine, Tsinghua University, 100084, Beijing, China.,Tsinghua-Peking Center for Life Sciences, 100084, Beijing, China
| | - Yu Guang
- Department of gynecology, The First Affiliated Hospital of Shenzhen University (The Second People's Hospital of Shenzhen) and Dapeng Maternity & Child Healthcare Hospital, 518028, Shenzhen, China
| | - Xue Gong
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases & Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 400016, Chongqing, China
| | - Yong He
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases & Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 400016, Chongqing, China
| | - Wei Zhou
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases & Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 400016, Chongqing, China
| | - Haiyang Wang
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases & Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 400016, Chongqing, China
| | - Ke Cheng
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases & Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 400016, Chongqing, China
| | - Yue Wang
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases & Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 400016, Chongqing, China
| | - Xiaowei Chen
- Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury, Third Military Medical University, 400038, Chongqing, China
| | - Peng Xie
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases & Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 400016, Chongqing, China.
| | - Zengcai V Guo
- IDG/McGovern Institute for Brain Research, School of Medicine, Tsinghua University, 100084, Beijing, China. .,Tsinghua-Peking Center for Life Sciences, 100084, Beijing, China.
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Li Q, Fu Y, Liu C, Meng Z. Transcranial Direct Current Stimulation of the Dorsolateral Prefrontal Cortex for Treatment of Neuropsychiatric Disorders. Front Behav Neurosci 2022; 16:893955. [PMID: 35711693 PMCID: PMC9195619 DOI: 10.3389/fnbeh.2022.893955] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/04/2022] [Indexed: 12/16/2022] Open
Abstract
Background The dorsolateral prefrontal cortex (DLPFC) is a key node of the frontal cognitive circuit. It is involved in executive control and many cognitive processes. Abnormal activities of DLPFC are likely associated with many psychiatric diseases. Modulation of DLPFC may have potential beneficial effects in many neural and psychiatric diseases. One of the widely used non-invasive neuromodulation technique is called transcranial direct current stimulation (or tDCS), which is a portable and affordable brain stimulation approach that uses direct electrical currents to modulate brain functions. Objective This review aims to discuss the results from the past two decades which have shown that tDCS can relieve clinical symptoms in various neurological and psychiatric diseases. Methods Here, we performed searches on PubMed to collect clinical and preclinical studies that using tDCS as neuromodulation technique, DLPFC as the stimulation target in treating neuropsychiatric disorders. We summarized the stimulation sites, stimulation parameters, and the overall effects in these studies. Results Overall, tDCS stimulation of DLPFC could alleviate the clinical symptoms of schizophrenia, depression, drug addiction, attention deficit hyperactivity disorder and other mental disorders. Conclusion The stimulation parameters used in these studies were different from each other. The lasting effect of stimulation was also not consistent. Nevertheless, DLPFC is a promising target for non-invasive stimulation in many psychiatric disorders. TDCS is a safe and affordable neuromodulation approach that has potential clinical uses. Larger clinical studies will be needed to determine the optimal stimulation parameters in each condition.
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Affiliation(s)
- Qing Li
- Medical School, Kunming University of Science and Technology, Kunming, China
- Shenzhen Key Laboratory of Drug Addiction, Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yu Fu
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Chang Liu
- Shenzhen Key Laboratory of Viral Vectors for Biomedicine, Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Fundamental Research Institutions, Shenzhen, China
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- *Correspondence: Chang Liu,
| | - Zhiqiang Meng
- Shenzhen Key Laboratory of Drug Addiction, Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen-Hong Kong Institute of Brain Science, Shenzhen Fundamental Research Institutions, Shenzhen, China
- CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Zhiqiang Meng,
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Harvey MP, Martel M, Houde F, Daguet I, Riesco E, Léonard G. Relieving Chronic Musculoskeletal Pain in Older Adults Using Transcranial Direct Current Stimulation: Effects on Pain Intensity, Quality, and Pain-Related Outcomes. FRONTIERS IN PAIN RESEARCH 2022; 3:817984. [PMID: 35529592 PMCID: PMC9069524 DOI: 10.3389/fpain.2022.817984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction Chronic pain is a significant health problem and is particularly prevalent amongst the elderly. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has been proposed to reduce chronic pain. The aim of this study was to evaluate and compare the efficacy of active and sham tDCS in reducing pain in older individuals living with chronic musculoskeletal pain. Materials and Methods Twenty-four older individuals (mean age: 68 ± 7 years) suffering from chronic musculoskeletal pain were randomized to receive either anodal tDCS over the contralateral motor cortex (2 mA, 20 min; n = 12) or sham tDCS (20 min; n = 12) for five consecutive days. Pain logbooks were used to measure pain intensity. Questionnaires (McGill Pain Questionnaire, Brief Pain Inventory, Beck Depression Inventory [BDI], Beck Anxiety Inventory, Pain Catastrophizing Scale [PCS], and Margolis Pain Drawing and Scoring System [MPDSS]) were also used to assess pain in its globality. Results Analysis of pain logbooks revealed that active tDCS led to a reduction in daily average pain intensity (all p ≤ 0.04), while sham tDCS did not produce any change (p = 0.15). Between-group comparisons for change in pain intensity reduction between active and sham tDCS showed a trend during treatment (p = 0.08) which was significant at the follow-up period (p = 0.02). Active tDCS also improved scores of all questionnaires (all p ≤ 0.02), while sham tDCS only reduced MPDSS scores (p = 0.04). Between-group comparisons for the pain-related outcomes showed significant differences for BDI et PCS after the last tDCS session. Conclusions These results suggest that anodal tDCS applied over the primary motor cortex is an effective modality to decrease pain in older individuals. tDCS can also improve other key outcomes, such as physical and emotional functioning, and catastrophic thinking.
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Affiliation(s)
- Marie-Philippe Harvey
- Research Center on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marylie Martel
- Research Center on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Francis Houde
- Research Center on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Inès Daguet
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Eléonor Riesco
- Research Center on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
- Faculté des sciences de l'activité physique, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Guillaume Léonard
- Research Center on Aging, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- École de réadaptation, Université de Sherbrooke, Sherbrooke, QC, Canada
- *Correspondence: Guillaume Léonard
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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: 14] [Impact Index Per Article: 7.0] [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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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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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: 4] [Impact Index Per Article: 2.0] [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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Lee J, Lee CW, Jang Y, You JS, Park YS, Ji E, Yu H, Oh S, Ryoo HA, Cho N, Park JY, Yoon J, Baek JH, Park HY, Ha TH, Myung W. Efficacy and safety of daily home-based transcranial direct current stimulation as adjunct treatment for bipolar depressive episodes: Double-blind sham-controlled randomized clinical trial. Front Psychiatry 2022; 13:969199. [PMID: 36203828 PMCID: PMC9530445 DOI: 10.3389/fpsyt.2022.969199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although transcranial direct current stimulation (tDCS) is known to be a promising therapeutic modality for unipolar depression, the efficacy and safety of tDCS for bipolar depressive episodes (BD) are still unknown and clinical trials of home-based tDCS treatment are scarce. As a result, we set out to investigate the efficacy and safety of home-based tDCS for the treatment BD. METHODS Participants (n = 64), diagnosed as bipolar disorder as per the diagnostic and statistical manual of mental disorders (DSM-5), were randomly assigned to receive tDCS. Hamilton Depression Rating Scale (HDRS-17) scores were measured at the baseline, week 2, 4, and 6, and home-based tDCS (for 30 min with 2 mA) was self-administered daily. RESULTS Of the 64 patients (15.6% bipolar disorder I, 84.4% bipolar disorder II), 41 patients completed the entire assessment. In the intention-to-treat analysis, time-group interaction for the HDRS-17 [F (3, 146.36) = 2.060; p = 0.108] and adverse effect differences between two groups were not statistically significant, except the pain score, which was higher in the active group than the sham group (week 0-2: p < 0.01, week 2-4: p < 0.05, and week 4-6: p < 0.01). CONCLUSION Even though we found no evidence for the efficacy of home-based tDCS for patients with BD, this tool was found to be a safe and tolerable treatment modality for BD. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/show/NCT03974815], identifier [NCT03974815].
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Affiliation(s)
- Jangwon Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Chan Woo Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yoonjeong Jang
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Ji Seon You
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yun Seong Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Eunjeong Ji
- Medical Research Collaborating Centre, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Hyeona Yu
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Sunghee Oh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Hyun A Ryoo
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Nayoung Cho
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Ji Yoon Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Joohyun Yoon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Youn Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Tae Hyon Ha
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
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32
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Li Z, Zhao X, Feng L, Zhao Y, Pan W, Liu Y, Yin M, Yue Y, Fang X, Liu G, Gao S, Zhang X, Huang NE, Du X, Chen R. Can Daytime Transcranial Direct Current Stimulation Treatment Change the Sleep Electroencephalogram Complexity of REM Sleep in Depressed Patients? A Double-Blinded, Randomized, Placebo-Controlled Trial. Front Psychiatry 2022; 13:851908. [PMID: 35664468 PMCID: PMC9157570 DOI: 10.3389/fpsyt.2022.851908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES The purpose of this study was to determine the effects of daytime transcranial direct current stimulation (tDCS) on sleep electroencephalogram (EEG) in patients with depression. METHODS The study was a double-blinded, randomized, controlled clinical trial. A total of 37 patients diagnosed with a major depression were recruited; 19 patients (13 females and 6 males mean age 44.79 ± 15.25 years) received tDCS active stimulation and 18 patients (9 females and 9 males; mean age 43.61 ± 11.89 years) received sham stimulation. Ten sessions of daytime tDCS were administered with the anode over F3 and the cathode over F4. Each session delivered a 2 mA current for 30 min per 10 working days. Hamilton-24 and Montgomery scales were used to assess the severity of depression, and polysomnography (PSG) was used to assess sleep structure and EEG complexity. Eight intrinsic mode functions (IMFs) were computed from each EEG signal in a channel. The sample entropy of the cumulative sum of the IMFs were computed to acquire high-dimensional multi-scale complexity information of EEG signals. RESULTS The complexity of Rapid Eye Movement (REM) EEG signals significantly decreased intrinsic multi-scale entropy (iMSE) (1.732 ± 0.057 vs. 1.605 ± 0.046, P = 0.0004 in the case of the C4 channel, IMF 1:4 and scale 7) after tDCS active stimulation. The complexity of the REM EEG signals significantly increased iMSE (1.464 ± 0.101 vs. 1.611 ± 0.085, P = 0.001 for C4 channel, IMF 1:4 and scale 7) after tDCS sham stimulation. There was no significant difference in the Hamilton-24 (P = 0.988), Montgomery scale score (P = 0.726), and sleep structure (N1% P = 0.383; N2% P = 0.716; N3% P = 0.772) between the two groups after treatment. CONCLUSION Daytime tDCS changed the complexity of sleep in the REM stage, and presented as decreased intrinsic multi-scale entropy, while no changes in sleep structure occurred. This finding indicated that daytime tDCS may be an effective method to improve sleep quality in depressed patients. Trial registration This trial has been registered at the ClinicalTrials.gov (protocol ID: TCHIRB-10409114, in progress).
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Affiliation(s)
- Zhe Li
- Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Lingfang Feng
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yu Zhao
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Wen Pan
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ying Liu
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ming Yin
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yan Yue
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiaojia Fang
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Guorui Liu
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Shigeng Gao
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiaobin Zhang
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | | | - Xiangdong Du
- Sleep Center, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Rui Chen
- Sleep Center, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Konicar L, Prillinger K, Klöbl M, Lanzenberger R, Antal A, Plener PL. Brain Stimulation for Emotion Regulation in Adolescents With Psychiatric Disorders: Study Protocol for a Clinical-Transdiagnostical, Randomized, Triple-Blinded and Sham-Controlled Neurotherapeutic Trial. Front Psychiatry 2022; 13:840836. [PMID: 35546931 PMCID: PMC9082670 DOI: 10.3389/fpsyt.2022.840836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anxiety, conduct and depressive disorders represent three highly prevalent psychiatric conditions in adolescents. A shared underpinning of these disorders is a shortcoming in emotion regulation, connected to the functioning of the ventromedial prefrontal cortex. Thus, an intervention able to target the suggested neural correlate seems to be highly desirable, aiming to hinder a maladaptive development of emotion regulation abilities and chronification of associated psychiatric disorders. As transcranial direct current stimulation (tDCS) was repeatedly demonstrated as a safe and non-invasive method to modulate specific brain activity, research is in demand to evaluate neurotherapeutic applications in adolescents with psychiatric disorders. METHOD This transdiagnostic, randomized, triple-blind and sham-controlled clinical neurostimulation trial primary aims to investigate if emotion regulation abilities are increased after tDCS in adolescents with psychiatric disorders. Secondly, disorder-specific changes in the anxiety, depression or conduct disorder will be investigated, as well as changes in quality of life, and cognitive and emotional functioning after tDCS intervention. We will include 108 adolescents with psychiatric disorders, displaying a substantial deficit in emotion regulation. Of these, one third each has to be primarily diagnosed with a depressive, anxiety or conduct disorder, respectively. Participants will be randomized to the experimental group (n = 54) receiving real anodal tDCS, or to the control group (n = 54) receiving sham tDCS. Brain stimulation will be applied for 20 min on five consecutive days twice targeting the ventromedial prefrontal cortex (vmPFC). Changes in emotion regulation, together with changes in disorder-specific clinical symptoms will be recorded by multi-informant psychological ratings. To inspect changes in behavior and gaze, computerized tasks and an eye tracker system will be used. Changes in brain responses to emotional and cognitive stimuli will be examined with three functional magnetic resonance imaging (fMRI) paradigms. In addition, a resting state MRI will be acquired to investigate possible changes in brain connectivity. DISCUSSION By investigating "emotion regulation" as transdiagnostic treatment target, this project is oriented toward the Research Domain Criteria framework with a dimensional view on mental illness. The study aims at investigating the potential of tDCS as non-invasive intervention for depressive, anxiety and conduct disorders in adolescents and broadening the scientific foundation for its clinical application. CLINICAL TRIAL REGISTRATION The study is ongoing and has been registered in the German Registry of Clinical Trials (DRKS-ID: DRKS00025601X) on the 28.06.2021.
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Affiliation(s)
- Lilian Konicar
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Manfred Klöbl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Andrea Antal
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Department of Child and Adolescents Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
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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: 25] [Impact Index Per Article: 8.3] [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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Mardani P, Zolghadriha A, Dadashi M, Javdani H, Mousavi SE. Effect of medication therapy combined with transcranial direct current stimulation on depression and response inhibition of patients with bipolar disorder type I: a clinical trial. BMC Psychiatry 2021; 21:579. [PMID: 34789181 PMCID: PMC8596350 DOI: 10.1186/s12888-021-03592-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Bipolar Disorder (BD) is one of the most common mental disorders associated with depressive symptoms and impairment in executive functions such as response inhibition. This study aimed to investigate the effectiveness of medication therapy combined with Transcranial Direct Current Stimulation (tDCS) on depression and response inhibition of patients with BD. METHOD This is a double-blinded randomized clinical trial with pretest, posttest, and follow-up design. Participants were 30 patients with BD randomly assigned to two groups of Medication+tDCS (n = 15, receiving medications plus tDCS with 2 mA intensity over dorsolateral prefrontal cortex for 10 days, two sessions per day each for 20 min) and Medication (n = 15, receiving mood stabilizers including 2-5 tables of 300 mg (mg) lithium, 200 mg sodium valproate, and 200 mg carbamazepine two times per day). Pretest, posttest and 3-month follow-up assessments were the 21-item Hamilton Depression Rating Scale (HDRS) and a Go/No-Go test. Collected data were analyzed in SPSS v.20 software. RESULTS The mean HDRS score in both groups was reduced after both interventional techniques, where the group received combined therapy showed more reduction (P < 0.01), although their effects were not maintained after 3 months. In examining response inhibition variable, only the combined therapy could reduce the commission error of patients under a go/no-go task (p < 0.05), but its effect was not maintained after 3 months. There was no significant difference in the group received medication therapy alone. CONCLUSION Medication in combination with tDCS can reduce the depressive symptoms and improve the response inhibition ability of people with BD. TRIAL REGISTRATION This study was registred by Iranian Registry of Clinical Trials (Parallel, ID: IRCT20191229045931N1 , Registration date: 24/08/2020).
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Affiliation(s)
- Parnaz Mardani
- grid.469309.10000 0004 0612 8427Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Ahmad Zolghadriha
- grid.469309.10000 0004 0612 8427Department of Psychiatry, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohsen Dadashi
- grid.469309.10000 0004 0612 8427Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossein Javdani
- grid.412606.70000 0004 0405 433XDepartment of Psychiatry, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Seyedeh Elnaz Mousavi
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Singh A, Erwin-Grabner T, Goya-Maldonado R, Antal A. Transcranial Magnetic and Direct Current Stimulation in the Treatment of Depression: Basic Mechanisms and Challenges of Two Commonly Used Brain Stimulation Methods in Interventional Psychiatry. Neuropsychobiology 2021; 79:397-407. [PMID: 31487716 DOI: 10.1159/000502149] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/16/2019] [Indexed: 12/12/2022]
Abstract
Noninvasive neuromodulation, including repetitive trans-cranial magnetic stimulation (rTMS) and direct current stimulation (tDCS), provides researchers and health care professionals with the ability to gain unique insights into brain functions and treat several neurological and psychiatric conditions. Undeniably, the number of published research and clinical papers on this topic is increasing exponentially. In parallel, several methodological and scientific caveats have emerged in the transcranial stimulation field; these include less robust and reliable effects as well as contradictory clinical findings. These inconsistencies are maybe due to the fact that research exploring the relationship between the methodological aspects and clinical efficacy of rTMS and tDCS is far from conclusive. Hence, additional work is needed to understand the mechanisms underlying the effects of magnetic stimulation and low-intensity transcranial electrical stimulation (TES) in order to optimize dosing, methodological designs, and safety aspects.
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Affiliation(s)
- Aditya Singh
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Tracy Erwin-Grabner
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Roberto Goya-Maldonado
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany, .,Institute for Medical Psychology, Medical Faculty, Otto-v.-Guericke University Magdeburg, Magdeburg, Germany,
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Herrera-Melendez AL, Bajbouj M, Aust S. Application of Transcranial Direct Current Stimulation in Psychiatry. Neuropsychobiology 2021; 79:372-383. [PMID: 31340213 DOI: 10.1159/000501227] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a neuromodulation technique, which noninvasively alters cortical excitability via weak polarizing currents between two electrodes placed on the scalp. Since it is comparably easy to handle, cheap to use and relatively well tolerated, tDCS has gained increasing interest in recent years. Based on well-known behavioral effects, a number of clinical studies have been performed in populations including patients with major depressive disorder followed by schizophrenia and substance use disorders, in sum with heterogeneous results with respect to efficacy. Nevertheless, the potential of tDCS must not be underestimated since it could be further improved by systematically investigating the various stimulation parameters to eventually increase clinical efficacy. The present article briefly explains the underlying physiology of tDCS, summarizes typical stimulation protocols and then reviews clinical efficacy for various psychiatric disorders as well as prevalent adverse effects. Future developments include combined and more complex interactions of tDCS with pharmacological or psychotherapeutic interventions. In particular, using computational models to individualize stimulation protocols, considering state dependency and applying closed-loop technologies will pave the way for tDCS-based personalized interventions as well as the development of home treatment settings promoting the role of tDCS as an effective treatment option for patients with mental health problems.
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Affiliation(s)
- Ana-Lucia Herrera-Melendez
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany,
| | - Malek Bajbouj
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sabine Aust
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Shen LL, Sun JB, Yang XJ, Deng H, Qin W, Du MY, Meng LX, Li N, Guo XY, Qiao WZ, Yang WQ, Liu P, Zeng X. Reassessment of the Effect of Transcutaneous Auricular Vagus Nerve Stimulation Using a Novel Burst Paradigm on Cardiac Autonomic Function in Healthy Young Adults. Neuromodulation 2021; 25:433-442. [PMID: 35396073 DOI: 10.1111/ner.13521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/14/2021] [Accepted: 07/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Transcutaneous auricular vagus nerve stimulation (taVNS) may modulate cardiac autonomic function. However, the response rate of the traditional tonic paradigm is low, and the results remain inconsistent. A recent pilot study presented a novel burst paradigm to activate the cardiac parasympathetic system, which might offer a new approach to treat cardiac autonomic function. The present study reassessed the effect of burst taVNS on modulating heart rate variability and explored the difference between burst and traditional tonic paradigms. MATERIALS AND METHODS Forty-two young adults were recruited for this study. Each participant underwent three types of taVNS with sham (30 sec of stimulation), tonic (25 Hz, 500 μsec), and burst (five pulses at 500 Hz every 200 msec) paradigms, respectively, with simultaneous electrocardiogram recording. One-way analysis of variance, multivariate analysis of variance, and linear regression were used for analysis. Multiple testing was performed using Bonferroni correction. RESULTS Both burst and tonic paradigms induced a significant decrease in heart rate, which continued until poststimulation, and increased cardiac parasympathetic activity. Moreover, two parasympathetic system indicators showed significant increase only in burst taVNS. The response rates during burst (35.7%) and tonic (38.1%) stimulations were both higher than that during sham stimulation (11.9%). The response to taVNS showed parameter specificity with few nonresponders to the tonic paradigm responding to the burst paradigm. The overall response rate increased from 38.1% in tonic taVNS to 54.8% in taVNS using both burst and tonic paradigms. For both burst and tonic responders, baseline cardiac parasympathetic activity was found to be significantly negatively correlated with changes during stimulation. CONCLUSION The burst parameter could be used as an alternative strategy for regulating cardiac parasympathetic function by taVNS, which has the potential to be used as a complementary paradigm to traditional tonic taVNS for promoting clinical treatment efficacy.
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Affiliation(s)
- Lin-Lin Shen
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Jin-Bo Sun
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Xue-Juan Yang
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Hui Deng
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Wei Qin
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Meng-Yu Du
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Ling-Xia Meng
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Nan Li
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Xiao-Yu Guo
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Wen-Zhou Qiao
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Wei-Qi Yang
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Peng Liu
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
| | - Xiao Zeng
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, Intelligent Non-Invasive Neuromodulation and Transformation Joint Laboratory, School of Life Science and Technology, Xidian University, Xi'an, China
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Gianni E, Bertoli M, Simonelli I, Paulon L, Tecchio F, Pasqualetti P. tDCS randomized controlled trials in no-structural diseases: a quantitative review. Sci Rep 2021; 11:16311. [PMID: 34381076 PMCID: PMC8357949 DOI: 10.1038/s41598-021-95084-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
The increasing number and quality of randomized controlled trials (RCTs) employing transcranial direct current stimulation (tDCS) denote the rising awareness of neuroscientific community about its electroceutical potential and opening to include these treatments in the framework of medical therapies under the indications of the international authorities. The purpose of this quantitative review is to estimate the recommendation strength applying the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria and PICO (population, intervention, comparison, outcome) model values for effective tDCS treatments on no-structural diseases, and to provide an estimate of Sham effect for future RCTs. Applying GRADE evaluation pathway, we searched in literature the tDCS-based RCTs in psychophysical diseases displaying a major involvement of brain electrical activity imbalances. Three independent authors agreed on Class 1 RCTs (18 studies) and meta-analyses were carried out using a random-effects model for pathologies sub-selected based on PICO and systemic involvement criteria. The meta-analysis integrated with extensive evidence of negligible side effects and low-cost, easy-to-use procedures, indicated that tDCS treatments for depression and fatigue in Multiple Sclerosis ranked between moderately and highly recommendable. For these interventions we reported the PICO variables, with left vs. right dorsolateral prefrontal target for 30 min/10 days against depression and bilateral somatosensory vs occipital target for 15 min/5 days against MS fatigue. An across-diseases meta-analysis devoted to the Sham effect provided references for power analysis in future tDCS RCTs on these clinical conditions. High-quality indications support tDCS as a promising tool to build electroceutical treatments against diseases involving neurodynamics alterations.
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Affiliation(s)
- Eugenia Gianni
- LET'S - ISTC - CNR, via Palestro 32, 00185, Rome, Italy
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Bertoli
- LET'S - ISTC - CNR, via Palestro 32, 00185, Rome, Italy
- Department of Imaging and Neuroscience and Clinical Sciences, University 'G. D'Annunzio' of Chieti-Pescara, Chieti, Italy
| | - Ilaria Simonelli
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
| | - Luca Paulon
- LET'S - ISTC - CNR, via Palestro 32, 00185, Rome, Italy
| | - Franca Tecchio
- LET'S - ISTC - CNR, via Palestro 32, 00185, Rome, Italy.
| | - Patrizio Pasqualetti
- Department of Public Health and Infectious Diseases, Section of Medical Statistics, University of Rome "Sapienza", Rome, Italy
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De Smet S, Nikolin S, Moffa A, Suen P, Vanderhasselt MA, Brunoni AR, Razza LB. Determinants of sham response in tDCS depression trials: a systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110261. [PMID: 33497753 DOI: 10.1016/j.pnpbp.2021.110261] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Randomised clinical trials (RCTs) investigating transcranial direct current stimulation (tDCS) efficacy for depression show significant heterogeneity in outcomes. OBJECTIVE To investigate the magnitude of the sham tDCS response and its potential moderators in the treatment of depression. METHODOLOGY A systematic review and aggregate meta-analysis (PROSPERO ID CRD42020161254). The systematic review was conducted in the PubMed, Scopus (EMBASE) and Cochrane Library databases. Only RCTs enrolling adult subjects with an acute depressive episode with a sham tDCS group were included. RESULTS Twenty-three studies (twenty-five datasets, 501 participants) were included. Sham tDCS response was large (Hedges' g = 1.09; 95% CI: 0.8;1.38). Secondary and subgroup analyses showed that sham protocols employing a ramp-up/ramp-down at the beginning and end of stimulation presented a significantly lower sham response compared to other protocols. Univariate meta-regression analyses found that sham response was associated with higher risk of blinding bias, and with thetreatment effect size of the active tDCS group. Subgroup analyses also showed that placement of the cathode over the lateral right frontal area (F8) presented a significantly lower sham response. Other moderators, including treatment resistance, baseline severity of depressive symptoms, and total charge delivered were not associated with the magnitude of the sham response. CONCLUSION The sham tDCS response was large. Our findings demonstrate the need for standardization of sham tDCS protocols and bring attention to important considerations that can guide future RCTs employing tDCS for the treatment of MDD.
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Affiliation(s)
- Stefanie De Smet
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - 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; Black Dog Institute, Sydney, Australia
| | - Paulo Suen
- Service of Interdisciplinary Neuromodulation, Neuroscience Laboratory (LIM-27), Department and Institute de Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Neuroscience Laboratory (LIM-27), Department and Institute de Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil; Department of Internal Medicine, University of São Paulo Medical School & University Hospital, University of São Paulo, Av. Prof Lineu Prestes 2565, 05508-000 São Paulo, Brazil
| | - Laís B Razza
- Service of Interdisciplinary Neuromodulation, Neuroscience Laboratory (LIM-27), Department and Institute de Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil.
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Melo L, Mosayebi-Samani M, Ghanavati E, Nitsche MA, Kuo MF. Dosage-Dependent Impact of Acute Serotonin Enhancement on Transcranial Direct Current Stimulation Effects. Int J Neuropsychopharmacol 2021; 24:787-797. [PMID: 34106250 PMCID: PMC8538892 DOI: 10.1093/ijnp/pyab035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The serotonergic system has an important impact on basic physiological and higher brain functions. Acute and chronic enhancement of serotonin levels via selective serotonin reuptake inhibitor administration impacts neuroplasticity in humans, as shown by its effects on cortical excitability alterations induced by non-invasive brain stimulation, including transcranial direct current stimulation (tDCS). Nevertheless, the interaction between serotonin activation and neuroplasticity is not fully understood, particularly considering dose-dependent effects. Our goal was to explore dosage-dependent effects of acute serotonin enhancement on stimulation-induced plasticity in healthy individuals. METHODS Twelve healthy adults participated in 7 sessions conducted in a crossover, partially double-blinded, randomized, and sham-controlled study design. Anodal and cathodal tDCS was applied to the motor cortex under selective serotonin reuptake inhibitor (20 mg/40 mg citalopram) or placebo medication. Motor cortex excitability was monitored by single-pulse transcranial magnetic stimulation. RESULTS Under placebo medication, anodal tDCS enhanced, and cathodal tDCS reduced, excitability for approximately 60-120 minutes after the intervention. Citalopram enhanced and prolonged the facilitation induced by anodal tDCS regardless of the dosage while turning cathodal tDCS-induced excitability diminution into facilitation. For the latter, prolonged effects were observed when 40 mg was administrated. CONCLUSIONS Acute serotonin enhancement modulates tDCS after-effects and has largely similar modulatory effects on motor cortex neuroplasticity regardless of the specific dosage. A minor dosage-dependent effect was observed only for cathodal tDCS. The present findings support the concept of boosting the neuroplastic effects of anodal tDCS by serotonergic enhancement, a potential clinical approach for the treatment of neurological and psychiatric disorders.
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Affiliation(s)
- Lorena Melo
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors (IfADo), Dortmund, Germany,International Graduate School of Neuroscience (IGSN), Ruhr-University Bochum, Germany
| | - Mohsen Mosayebi-Samani
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors (IfADo), Dortmund, Germany
| | - Elham Ghanavati
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors (IfADo), Dortmund, Germany
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors (IfADo), Dortmund, Germany,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Min-Fang Kuo
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors (IfADo), Dortmund, Germany,Correspondence: Min-Fang Kuo, MD, PhD, Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors (IfADo), Ardeystraße 67, 44139 Dortmund, Germany ()
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Zhang R, Lam CLM, Peng X, Zhang D, Zhang C, Huang R, Lee TMC. Efficacy and acceptability of transcranial direct current stimulation for treating depression: A meta-analysis of randomized controlled trials. Neurosci Biobehav Rev 2021; 126:481-490. [PMID: 33789158 DOI: 10.1016/j.neubiorev.2021.03.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a promising nonpharmacological intervention for treating depression. We aimed to provide an updated meta-analysis assessing the anti-depressant efficacy of tDCS. METHODS We searched the literature from the first available date to 30 December 2020 to identify relevant randomized controlled trials (RCTs). RESULTS 27 RCTs (N = 1204 patients, 653 in active tDCS and 551 in sham tDCS) were included. Active tDCS was superior to sham tDCS (g = 0.46, 95 % CI 0.15-0.76) in modulating depressive symptoms measured by depression rating scales. Active tDCS was also superior to sham tDCS in reducing response and remission rates, but these differences did not reach statistically significant levels (ORresponse = 1.75, 95 % CI 0.85-3.58; ORremission = 1.29, 95 % CI 0.59-2.83). The two groups had comparable dropout rates (OR = 1.28, 95 % CI 0.62-1.64). CONCLUSION For treatments of depressive episodes, tDCS may be efficacious. Specific tDCS parameters (e.g., a 2-mA stimulation current and 30-min sessions) and clinical characteristics (e.g., antidepressant-free) may augment the treatment efficacy of tDCS.
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Affiliation(s)
- Ruibin Zhang
- Cognitive Control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, 510515, China; Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Charlene L M Lam
- Laboratory of Clinical Psychology and Affective Neuroscience, The University of Hong Kong, Hong Kong, China
| | | | - Dongming Zhang
- Cognitive Control and Brain Healthy Laboratory, Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Chichen Zhang
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Ruiwang Huang
- School of Psychology, South China Normal University, Guangzhou, China.
| | - Tatia M C Lee
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China; Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong, China; Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong-Macao, Greater Bay Area, China.
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Song P, Li S, Hao W, Wei M, Liu J, Lin H, Hu S, Dai X, Wang J, Wang R, Wang Y. Corticospinal excitability enhancement with simultaneous transcranial near-infrared stimulation and anodal direct current stimulation of motor cortex. Clin Neurophysiol 2021; 132:1018-1024. [PMID: 33743296 DOI: 10.1016/j.clinph.2021.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Non-invasive brain stimulation (NIBS) is beneficial to many neurological and psychiatric disorders by modulating neuroplasticity and cortical excitability. However, recent studies evidence that single type of NIBS such as transcranial direct current stimulation (tDCS) does not have meaningful clinical therapeutic responses due to their small effect size. Transcranial near-infrared stimulation (tNIRS) is a novel form of NIBS. Both tNIRS and tDCS implement its therapeutic effects by modulating cortical excitability but with different mechanisms. We hypothesized that simultaneous tNIRS and tDCS is superior to single stimulation, leading to a greater cortical excitability. METHODS Sixteen healthy subjects participated in a double-blind, sham-controlled, cross-over designed study. Motor evoked potentials (MEPs) were used to measure motor cortex excitability. The changes of MEP were calculated and compared in the sham condition, tDCS stimulation condition, tNIRS condition and the simultaneous tNIRS and anodal tDCS condition. RESULTS tDCS alone and tNIRS alone both elicited higher MEP after stimulation, while the MEP amplitude in the simultaneous tNIRS and tDCS condition was significantly higher than either tNIRS alone or tDCS alone. The enhancement lasted up to at least 30 minutes after stimulation, indicating simultaneous 820 nm tNIRS with 2 mA anodal tDCS have a synergistic effect on cortical plasticity. CONCLUSIONS Simultaneous application of tNIRS with tDCS produces a stronger cortical excitability effect. SIGNIFICANCE The simultaneous tNIRS and tDCS is a promising technology with exciting potential as a means of treatment, neuro-enhancement, or neuro-protection.
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Affiliation(s)
- Penghui Song
- Central Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China; Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Geriatric Medical Research Center, Beijing, China; Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Siran Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wensi Hao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Min Wei
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianghong Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hua Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shimin Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaona Dai
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China.
| | - Rong Wang
- Central Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Geriatric Medical Research Center, Beijing, China; Beijing Institute for Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neuromodulation, Beijing, China; Beijing Institute for Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
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Suleman R, Tucker BV, Dursun SM, Demas ML. The Neurostimulation of the Brain in Depression Trial: Protocol for a Randomized Controlled Trial of Transcranial Direct Current Stimulation in Treatment-Resistant Depression. JMIR Res Protoc 2021; 10:e22805. [PMID: 33729165 PMCID: PMC8088846 DOI: 10.2196/22805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/20/2021] [Accepted: 02/18/2021] [Indexed: 01/28/2023] Open
Abstract
Background Major depressive disorder (MDD) is the second highest cause of disability worldwide. Standard treatments for MDD include medicine and talk therapy; however, approximately 1 in 5 Canadians fail to respond to these approaches and must consider alternatives. Transcranial direct current stimulation (tDCS) is a safe, noninvasive method that uses electrical stimulation to change the activation pattern of different brain regions. By targeting those regions known to be affected in MDD, tDCS may be useful in ameliorating treatment-resistant depression. Objective The objective of the Neurostimulation of the Brain in Depression trial is to compare the effectiveness of active versus sham tDCS in treating patients with ultraresistant MDD. The primary outcome will be the improvement in depressive symptoms, as measured by the change on the Mongtomery-Asberg Depression Rating Scale. Secondary outcomes will include changes in the Quick Inventory of Depressive Symptomatology Scale (subjective assessment), the World Health Organization Disability Assessment Schedule 2.0 (functional assessment), and the Screen for Cognitive Impairment in Psychiatry (cognitive assessment). Adverse events will be captured using the Young Mania Rating Scale; tDCS Adverse Events Questionnaire; Frequency, Intensity, and Burden of Side Effects Rating Scale; and Patient-Rated Inventory of Side Effects Scale. A parallel component of the study will involve assaying for baseline language function and the effect of treatment on language using an exploratory acoustic and semantic corpus analysis on recorded interviews. Participant accuracy and response latency on an auditory lexical decision task will also be evaluated. Methods We will recruit inpatients and outpatients in the city of Edmonton, Alberta, and will deliver the study interventions at the Grey Nuns and University of Alberta Hospitals. Written informed consent will be obtained from all participants before enrollment. Eligible participants will be randomly assigned, in a double-blinded fashion, to receive active or sham tDCS, and they will continue receiving their usual pharmacotherapy and psychotherapy throughout the trial. In both groups, participants will receive 30 weekday stimulation sessions, each session being 30 minutes in length, with the anode over the left dorsolateral prefrontal cortex and the cathode over the right. Participants in the active group will be stimulated at 2 mA throughout, whereas the sham group will receive only a brief period of stimulation to mimic skin sensations felt in the active group. Measurements will be conducted at regular points throughout the trial and 30 days after trial completion. Results The trial has been approved by the University of Alberta Research Ethics Board and is scheduled to commence in June 2021. The target sample size is 60 participants. Conclusions This is a protocol for a multicenter, double-blinded, randomized controlled superiority trial comparing active versus sham tDCS in patients with treatment-resistant MDD. Trial Registration ClinicalTrials.gov NCT04159012; http://clinicaltrials.gov/ct2/show/NCT04159012. International Registered Report Identifier (IRRID) PRR1-10.2196/22805
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Affiliation(s)
- Raheem Suleman
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Benjamin V Tucker
- Department of Linguistics, Faculty of Arts, University of Alberta, Edmonton, AB, Canada
| | - Serdar M Dursun
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Grey Nuns Community Hospital, Edmonton, AB, Canada
| | - Michael L Demas
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Grey Nuns Community Hospital, Edmonton, AB, Canada
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Goerigk S, Cretaz E, Sampaio-Junior B, Vieira ÉLM, Gattaz W, Klein I, Lafer B, Teixeira AL, Carvalho AF, Lotufo PA, Benseñor IM, Bühner M, Padberg F, Brunoni AR. Effects of tDCS on neuroplasticity and inflammatory biomarkers in bipolar depression: Results from a sham-controlled study. Prog Neuropsychopharmacol Biol Psychiatry 2021; 105:110119. [PMID: 33022345 DOI: 10.1016/j.pnpbp.2020.110119] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We investigated the role of peripheral biomarkers associated with neuroplasticity and immune-inflammatory processes on the effects of transcranial direct current stimulation (tDCS), a safe, affordable, and portable non-invasive neuromodulatory treatment, in bipolar depression. METHODS This is an exploratory analysis using a dataset from the sham-controlled study the Bipolar Depression Electrical Treatment Trial (BETTER)(clinicaltrials.govNCT02152878). Participants were 52 adults with type I or II bipolar disorder in a moderate-to-severe depressive episode, randomized to 12 bifrontal active or sham tDCS sessions over a 6-week treatment course. Plasma levels of brain derived neurotrophic factor (BDNF), glial cell derived neurotrophic factor (GDNF), interleukins (IL) 2, 4, 6, 8, 10, 18, 33, 1β, 12p70, 17a, interferon gamma (IFN), tumor necrosis factor alpha (TNF) and its soluble receptors 1 and 2, ST2, and KLOTHO were investigated at baseline and endpoint. We performed analyses unadjusted for multiple testing to evaluate whether baseline biomarkers were predictive for depression improvement and changed during treatment using linear regression models. RESULTS A time x group interaction (Cohen's d: -1.16, 95% CI = -1.96 to -0.3, p = .005) was found for IL-8, with greater reductions after active tDCS. Higher baseline IL-6 plasma levels was associated with symptomatic improvement after tDCS (F(1,43) = 5.43; p = .025). Other associations were not significant. CONCLUSIONS Our exploratory findings suggested that IL-6 is a potential predictor of tDCS response and IL-8 might decrease after tDCS; although confirmatory studies are warranted due to the multiplicity of comparisons.
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Affiliation(s)
- Stephan Goerigk
- Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Munich, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Nußbaumstraße 7, 80336 Munich, Germany; Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - Eric Cretaz
- ECT Service, Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Bipolar Disorder Research Program, Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Érica Leandro Marciano Vieira
- Interdisciplinary Laboratory of Medical Investigation, Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, Brazil; Centre for Addiction and Mental Healthy (CAMH), Toronto, ON, Canada
| | - Wagner Gattaz
- 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, São Paulo, Brazil
| | - Izio Klein
- 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, São Paulo, Brazil
| | - Beny Lafer
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Antônio Lúcio Teixeira
- Interdisciplinary Laboratory of Medical Investigation, Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, Brazil; Neuropsychiatry Program, Department of Psychiatry and Behavioral Science, UT Health, Houston, United States of America
| | - André F Carvalho
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Healthy (CAMH), Toronto, ON, Canada
| | - Paulo A Lotufo
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, 05508-000 São Paulo, Brazil
| | - Isabela M Benseñor
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, 05508-000 São Paulo, Brazil
| | - Markus Bühner
- Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Nußbaumstraße 7, 80336 Munich, Germany
| | - André R 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, São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, 05508-000 São Paulo, Brazil.
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Gaudreault PO, Sharma A, Datta A, Nakamura-Palacios EM, King S, Malaker P, Wagner A, Vasa D, Parvaz MA, Parra LC, Alia-Klein N, Goldstein RZ. A double-blind sham-controlled phase 1 clinical trial of tDCS of the dorsolateral prefrontal cortex in cocaine inpatients: Craving, sleepiness, and contemplation to change. Eur J Neurosci 2021; 53:3212-3230. [PMID: 33662163 DOI: 10.1111/ejn.15172] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 02/06/2023]
Abstract
Impaired inhibitory control accompanied by enhanced salience attributed to drug-related cues, both associated with function of the dorsolateral prefrontal cortex (dlPFC), are hallmarks of drug addiction, contributing to worse symptomatology including craving. dlPFC modulation with transcranial direct current stimulation (tDCS) previously showed craving reduction in inpatients with cocaine use disorder (CUD). Our study aimed at assessing feasibility of a longer tDCS protocol in CUD (15 versus the common five/10 sessions) and replicability of previous results. In a randomized double-blind sham-controlled protocol, 17 inpatients with CUD were assigned to either a real-tDCS (right anodal/left cathodal) or a sham-tDCS condition for 15 sessions. Following the previous report, primary outcome measures were self-reported craving, anxiety, depression, and quality of life. Secondary measures included sleepiness, readiness to change drug use, and affect. We also assessed cognitive function including impulsivity. An 88% retention rate demonstrated feasibility. Partially supporting the previous results, there was a trend for self-reported craving to decrease in the real-tDCS group more than the sham-group, an effect that would reach significance with 15 subjects per group. Quality of life and impulsivity improved over time in treatment in both groups. Daytime sleepiness and readiness to change drug use showed significant Group × Time interactions whereby improvements were noted only in the real-tDCS group. One-month follow-up suggested transient effects of tDCS on sleepiness and craving. These preliminary results suggest the need for including more subjects to show a unique effect of real-tDCS on craving and examine the duration of this effect. After replication in larger sample sizes, increased vigilance and motivation to change drug use in the real-tDCS group may suggest fortification of dlPFC-supported executive functions.
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Affiliation(s)
- Pierre-Olivier Gaudreault
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Akarsh Sharma
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - Ester M Nakamura-Palacios
- Program of Post-Graduation in Physiological Sciences, Federal University of Espirito Santo, Vitoria-ES, Brazil
| | - Sarah King
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Pias Malaker
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ariella Wagner
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Devarshi Vasa
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Muhammad A Parvaz
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Lucas C Parra
- Biomedical Engineering Department, City College of New York, New York City, NY, USA
| | - Nelly Alia-Klein
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Rita Z Goldstein
- Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Distinct trajectories of response to prefrontal tDCS in major depression: results from a 3-arm randomized controlled trial. Neuropsychopharmacology 2021; 46:774-782. [PMID: 33349674 PMCID: PMC8027859 DOI: 10.1038/s41386-020-00935-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/22/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a safe, effective treatment for major depressive disorder (MDD). While antidepressant effects are heterogeneous, no studies have investigated trajectories of tDCS response. We characterized distinct improvement trajectories and associated baseline characteristics for patients treated with prefrontal tDCS, an active pharmacotherapy (escitalopram), and placebo. This is a secondary analysis of a randomized, non-inferiority, double-blinded trial (ELECT-TDCS, N = 245). Participants were diagnosed with an acute unipolar, nonpsychotic, depressive episode, and presented Hamilton Depression Rating Scale (17-items, HAM-D) scores ≥17. Latent trajectory modeling was used to identify HAM-D response trajectories over a 10-week treatment. Top-down (hypothesis-driven) and bottom-up (data-driven) methods were employed to explore potential predictive features using, respectively, conservatively corrected regression models and a cross-validated stability ranking procedure combined with elastic net regularization. Three trajectory classes that were distinct in response speed and intensity (rapid, slow, and no/minimal improvement) were identified for escitalopram, tDCS, and placebo. Differences in response and remission rates were significant early for all groups. Depression severity, use of benzodiazepines, and age were associated with no/minimal improvement. No significant differences in trajectory assignment were found in tDCS vs. placebo comparisons (38.3, 34, and 27.6%; vs. 23.3, 43.3, and 33.3% for rapid, slow, and no/minimal trajectories, respectively). Additional features are suggested in bottom-up analyses. Summarily, groups treated with tDCS, escitalopram, and placebo differed in trajectory class distributions and baseline predictors of response. Our results might be relevant for designing further studies.
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Lin YY, Chang CC, Huang CCY, Tzeng NS, Kao YC, Chang HA. Efficacy and neurophysiological predictors of treatment response of adjunct bifrontal transcranial direct current stimulation (tDCS) in treating unipolar and bipolar depression. J Affect Disord 2021; 280:295-304. [PMID: 33221715 DOI: 10.1016/j.jad.2020.11.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/19/2020] [Accepted: 11/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although add-on transcranial direct current stimulation (tDCS) is a promising intervention for treating unipolar (UD) and bipolar depression (BD), its moderate antidepressant efficacy urges research into biomarkers for predicting therapeutic response and achieving highly targeted applications. METHODS This open-label trial enrolled UD (N=58) and BD (N=22) patients who had failed 1 or more trials of adequate pharmacologic interventions (ClinicalTrials.gov ID: NCT03287037). Bifrontal tDCS (anode/cathode: F3/F4) was applied using a 2 mA current for 20 min, twice daily, for 5 consecutive weekdays. Depression was measured with Hamilton Depression Rating Scale-17 (HAMD) at baseline, after 10-session stimulation, 1- and 4-week follow-ups. Heart rate (HR) and heart rate variability (HRV) was measured at baseline, during the initial 5 min of the 1st session, after 10-session stimulation, 1- and 4-week follow-ups. Cognitive performance and other outcomes were also assessed. RESULTS Bifrontal tDCS rapidly and equally improved depression in both groups. The effects persisted until the end of the trial. Both groups had similar improvements in cognitive performance, anxiety, and psychosocial functioning. Compared with baseline, increased vagally-mediated HRV was observed one month after tDCS for both groups. A positive correlation was found between HR deceleration within the 1st session and treatment response after 10-session tDCS only among UD patients, explaining 20% of the variance. CONCLUSION tDCS as an adjunct therapy is effective for both UD and BD. Data suggest that the greater the increase in parasympathetic signaling during the 1st session, the better the clinical response after 10-session tDCS for UD patients.
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Affiliation(s)
- Yen-Yue Lin
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Department of Life Sciences, National Central University, Taoyuan, Taiwan
| | - Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Suen PJC, Doll S, Batistuzzo MC, Busatto G, Razza LB, Padberg F, Mezger E, Bulubas L, Keeser D, Deng ZD, Brunoni AR. Association between tDCS computational modeling and clinical outcomes in depression: data from the ELECT-TDCS trial. Eur Arch Psychiatry Clin Neurosci 2021; 271:101-110. [PMID: 32279145 PMCID: PMC8100980 DOI: 10.1007/s00406-020-01127-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/30/2020] [Indexed: 12/19/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation intervention investigated for the treatment of depression. Clinical results have been heterogeneous, partly due to the variability of electric field (EF) strength in the brain owing to interindividual differences in head anatomy. Therefore, we investigated whether EF strength was correlated with behavioral changes in 16 depressed patients using simulated electric fields in real patient data from a controlled clinical trial. We hypothesized that EF strength in the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), brain regions implicated in depression pathophysiology, would be associated with changes in depression, mood and anxiety scores. SimNIBS were used to simulate individual electric fields based on the MRI structural T1-weighted brain scans of depressed subjects. Linear regression models showed, at the end of the acute treatment phase, that simulated EF strength was inversely associated with negative affect in the bilateral ACC (left: β = - 160.463, CI [- 291.541, - 29.385], p = 0.021; right: β = - 189.194, CI [- 289.479, - 88.910], p = 0.001) and DLPFC (left: β = - 93.210, CI [- 154.960, - 31.461], p = 0.006; right: β = - 82.564, CI [- 142.867, - 22.262], p = 0.011) and with depression scores in the left ACC (β = - 156.91, CI [- 298.51, - 15.30], p = 0.033). No association between positive affect or anxiety scores, and simulated EF strength in the investigated brain regions was found. To conclude, our findings show preliminary evidence that EF strength simulations might be associated with further behavioral changes in depressed patients, unveiling a potential mechanism of action for tDCS. Further studies should investigate whether individualization of EF strength in key brain regions impact clinical response.
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Affiliation(s)
- Paulo J. C. Suen
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Sarah Doll
- Department of Psychology, University of Münster, Münster, Germany
| | | | - Geraldo Busatto
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA) and Laboratory of Psychiatric Neuroimaging, Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Lais B. Razza
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, Service of Interdisciplinary Neuromodulation, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Instituto de Psiquiatria, R Dr Ovidio Pires de Campos 785, 2o andar, Ala Sul, São Paulo, CEP 05403-000, Brazil
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Eva Mezger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Lucia Bulubas
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany,Department of Clinical Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Andre R. Brunoni
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, Service of Interdisciplinary Neuromodulation, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Instituto de Psiquiatria, R Dr Ovidio Pires de Campos 785, 2o andar, Ala Sul, São Paulo, CEP 05403-000, Brazil,Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo and Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, São Paulo 05508-000, Brazil
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Cognitive outcomes of the bipolar depression electrical treatment trial (BETTER): a randomized, double-blind, sham-controlled study. Eur Arch Psychiatry Clin Neurosci 2021; 271:93-100. [PMID: 32221654 DOI: 10.1007/s00406-020-01121-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022]
Abstract
Bipolar depression is associated with marked cognitive deficits. Pharmacological treatments for this condition are limited and may aggravate depressive and cognitive symptoms. Therefore, therapeutic interventions that preserve adequate cognitive functioning are necessary. Our previous results demonstrated significant clinical efficacy of transcranial direct current stimulation (tDCS) in the Bipolar Depression Electrical Treatment Trial (BETTER). Here, cognitive outcomes of this study are reported. We randomized 59 patients with bipolar disorder I or II in an acute depressive episode to receive active (12 2 mA, 30-min, anodal-left, cathodal-right prefrontal cortex tDCS sessions) or sham tDCS. Patients were on stable pharmacological regimen for at least 2 weeks. A battery of 12 neuropsychological assessments in five cognitive domains (attention and processing speed, memory, language, inhibitory control, and working memory and executive function) was performed at baseline, after two weeks and at endpoint (week 6). No significant differences between groups over 6 weeks of treatment were observed for any cognitive outcomes. Moreover, no decrease in cognitive performance was observed. Our findings warrant further replication in larger studies. Trial Registration: clinicaltrials.gov Identifier: NCT02152878.
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