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Hao W, Liu Y, Gao Y, Gong X, Ning Y. Transcranial direct current stimulation for the treatment of post-stroke depression: A systematic review. Front Neurol 2023; 13:955209. [PMID: 36742053 PMCID: PMC9893893 DOI: 10.3389/fneur.2022.955209] [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: 06/28/2022] [Accepted: 12/22/2022] [Indexed: 01/20/2023] Open
Abstract
Background Post-stroke depression (PSD) is not only a frequent neuropsychiatric manifestation secondary to stroke but is also associated with disability, poor rehabilitation outcomes, sleep disorders, cognitive impairment, and increased mortality. Transcranial direct current stimulation (tDCS), a primary modality of non-invasive brain stimulation (NIBS), has shown promising clinical results in the rehabilitation of patients with PSD recently. The primary aim of this systematic review is to assess the effects of tDCS on PSD. Methods PubMed and Cochrane databases were used for paper identification up to May 2022. Only English language studies and published data were taken into consideration. The methodological quality of selected studies was assessed according to the modified Sackett Scale, based on Physiotherapy Evidence Database (PEDro) scores. Results Six experimental studies were included for the PSD treatment of tDCS and all of them reported that, following the intervention of tDCS, the experimental group shows a statistically significant decrease in the depression level in accordance with different assessment scales. Conclusion This article simply aims at providing a comprehensive overview of the raw data reported in this field to date. Based on the current evidence, tDCS presents promising results for the treatment of PSD. Moreover, tDCS is also effective in PSD patients with aphasia or CPSP. However, an optimal stimulation protocol is needed to formulate. Thus, the development of robustly controlled, randomized, and high-quality clinical trials to further assess the utility of tDCS as a therapeutic tool for the treatment of PSD survivors is encouraged. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023322076, identifier: CRD42023322076.
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Affiliation(s)
- Wenjian Hao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China,Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
| | - Yong Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China,Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China,*Correspondence: Yong Liu ✉
| | - Yuling Gao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaoyang Gong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yi Ning
- Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China
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Konstantinou GN, Vigod SN, Mehta S, Daskalakis ZJ, Blumberger DM. "A systematic review of non-invasive neurostimulation for the treatment of depression during pregnancy". J Affect Disord 2020; 272:259-268. [PMID: 32553366 DOI: 10.1016/j.jad.2020.03.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/20/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Antidepressant use in pregnancy is associated with high levels of decision-making difficulty for patients, and psychotherapy may not be effective for severe symptoms. Alternative treatment options are needed. We conducted a systematic review of the clinical effects and tolerability of non-invasive neurostimulation: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), trigeminal nerve stimulation (TNS), and transcutaneous vagus nerve stimulation (tVNS) for the treatment of antenatal depression. METHODS We searched PubMed, Google Scholar and Scopus for published articles in English (1990 to June 2019). Two reviewers reviewed full-text articles, assessed quality, and extracted data on maternal psychiatric, pregnancy and neonatal outcomes. RESULTS Of 565 articles, 21 met inclusion criteria: two RCTs (1 rTMS; 1 tDCS), four open-label studies (3 rTMS; 1 tDCS), three case series (3 rTMS), and twelve case reports (9 rTMS; 1 tDCS; 1 tACS; 1 TNS). In all but one published study (1 rTMS), non-invasive neurostimulation resulted in either response or remission of antenatal depression. Minor maternal side effects were reported in rTMS and tDCS studies, but not in other modalities. Fetal adverse effects were not reported in any intervention. A small proportion of participants dropped out of treatment (rTMS, tDCS). LIMITATIONS Very few randomized trials have been conducted and there is significant heterogeneity in the parameters of the modalities that have been studied. CONCLUSIONS Non-invasive neurostimulation holds promise as a potentially effective and feasible alternative treatment for antenatal depression. Strategies to enhance recruitment of pregnant women into non-invasive neurostimulation trials that have longitudinal follow-up are needed.
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Affiliation(s)
- Gerasimos N Konstantinou
- Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Shobha Mehta
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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3
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Bulteau S, Laurin A, Volteau C, Dert C, Lagalice L, Schirr-Bonnans S, Bukowski N, Guitteny M, Simons L, Cabelguen C, Pichot A, Tessier F, Bonnin A, Lepage A, Vanelle JM, Sauvaget A, Riche VP. Cost-utility analysis of curative and maintenance repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant unipolar depression: a randomized controlled trial protocol. Trials 2020; 21:312. [PMID: 32248820 PMCID: PMC7133008 DOI: 10.1186/s13063-020-04255-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/14/2020] [Indexed: 12/28/2022] Open
Abstract
Background Depression is a debilitating and costly disease for our society, especially in the case of treatment-resistant depression (TRD). Repetitive transcranial magnetic stimulation (rTMS) is an effective adjuvant therapy in treatment-resistant unipolar and non-psychotic depression. It can be applied according to two therapeutic strategies after an initial rTMS cure: a further rTMS cure can be performed at the first sign of relapse or recurrence, or systematic maintenance rTMS (M-rTMS) can be proposed. TMS adjuvant to treatment as usual (TAU) could improve long-term prognosis. However, no controlled study has yet compared the cost-effectiveness of these two additional rTMS therapeutic strategies versus TAU alone. Methods/design This paper focuses on the design of a health-economic, prospective, randomized, double-blind, multicenter study with three parallel arms carried out in France. This study assesses the cost-effectiveness of the adjunctive and maintenance low frequency rTMS on the right dorsolateral prefrontal cortex versus TAU alone. A total of 318 patients suffering from a current TRD will be enrolled. The primary endpoint is to investigate the incremental cost-effectiveness ratio (ICER) (ratio costs / quality-adjusted life-years [QALY] measured by the Euroqol Five Dimension Questionnaire) over 12 months in a population of patients assigned to one of three arms: systematic M-rTMS for responders (arm A); additional new rTMS cure in case of mood deterioration among responders (arm B); and a placebo arm (arm C) in which responders are allocated in two subgroups: sham systematic M-rTMS and supplementary rTMS course in case of mood deterioration. ICER and QALYs will be compared between arm A or B versus arm C. The secondary endpoints in each three arms will be: ICER at 24 months; the cost-utility ratio analysis at 12 and 24 months; 5-year budget impact analysis; and prognosis factors of rTMS. The following criteria will be compared between arm A or B and arm C: rates of responders; remission and disease-free survival; clinical evolution; tolerance; observance; treatment modifications; hospitalization; suicide attempts; work stoppage; marital / professional statues; and quality of life at 12 and 24 months. Discussion The purpose of our study is to check the cost-effectiveness of rTMS and we will discuss its economic impact over time. In the case of significant decrease in the depression costs and expenditures associated with a good long-term prognosis (sustained response and remission) and tolerance, rTMS could be considered as an efficient treatment within the armamentarium for resistant unipolar depression. Trial registration ClinicalTrials.gov, NCT03701724. Registered on 10 October 2018. Protocol Amendment Version 2.0 accepted on 29 June 2019.
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Affiliation(s)
- Samuel Bulteau
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France.
| | - Andrew Laurin
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | - Cécile Dert
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Lydie Lagalice
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | - Nicolas Bukowski
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Marie Guitteny
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Luc Simons
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | - Anne Pichot
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Fabienne Tessier
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Annabelle Bonnin
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Adeline Lepage
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | | | | | - Anne Sauvaget
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
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Rosenblat JD, Kurdyak P, Cosci F, Berk M, Maes M, Brunoni AR, Li M, Rodin G, McIntyre RS, Carvalho AF. Depression in the medically ill. Aust N Z J Psychiatry 2020; 54:346-366. [PMID: 31749372 DOI: 10.1177/0004867419888576] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. METHODS Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. RESULTS Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug-drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. LIMITATIONS Non-systematic review of the literature. CONCLUSION Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.
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Affiliation(s)
- Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia.,Centre of Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Madeline Li
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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5
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Bulteau S, Guirette C, Brunelin J, Poulet E, Trojak B, Richieri R, Szekely D, Bennabi D, Yrondi A, Rotharmel M, Bougerol T, Dall’Igna G, Attal J, Benadhira R, Bouaziz N, Bubrovszky M, Calvet B, Dollfus S, Foucher J, Galvao F, Gay A, Haesebaert F, Haffen E, Jalenques I, Januel D, Jardri R, Millet B, Nathou C, Nauczyciel C, Plaze M, Rachid F, Vanelle JM, Sauvaget A. Troubles de l’humeur : quand recourir à la stimulation magnétique transcrânienne ? Presse Med 2019; 48:625-646. [DOI: 10.1016/j.lpm.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/30/2018] [Accepted: 01/31/2019] [Indexed: 12/24/2022] Open
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6
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Ferrucci R, Mrakic-Sposta S, Gardini S, Ruggiero F, Vergari M, Mameli F, Arighi A, Spallazzi M, Barocco F, Michelini G, Pietroboni AM, Ghezzi L, Fumagalli GG, D'Urso G, Caffarra P, Scarpini E, Priori A, Marceglia S. Behavioral and Neurophysiological Effects of Transcranial Direct Current Stimulation (tDCS) in Fronto-Temporal Dementia. Front Behav Neurosci 2018; 12:235. [PMID: 30420799 PMCID: PMC6215856 DOI: 10.3389/fnbeh.2018.00235] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/20/2018] [Indexed: 11/13/2022] Open
Abstract
Fronto-temporal dementia (FTD) is the clinical-diagnostic term that is now preferred to describe patients with a range of progressive dementia syndromes associated with focal atrophy of the frontal and anterior temporal cerebral regions. Currently available FTD medications have been used to control behavioral symptoms, even though they are ineffective in some patients, expensive and may induce adverse effects. Alternative therapeutic approaches are worth pursuing, such as non-invasive brain stimulation with transcranial direct current (tDCS). tDCS has been demonstrated to influence neuronal excitability and reported to enhance cognitive performance in dementia. The aim of this study was to investigate whether applying Anodal tDCS (2 mA intensity, 20 min) over the fronto-temporal cortex bilaterally in five consecutive daily sessions would improve cognitive performance and behavior symptoms in FTD patients, also considering the neuromodulatory effect of stimulation on cortical electrical activity measured through EEG. We recruited 13 patients with FTD and we tested the effect of Anodal and Sham (i.e., placebo) tDCS in two separate experimental sessions. In each session, at baseline (T0), after 5 consecutive days (T1), after 1 week (T2), and after 4 weeks (T3) from the end of the treatment, cognitive and behavioral functions were tested. EEG (21 electrodes, 10-20 international system) was recorded for 5 min with eyes closed at the same time points in nine patients. The present findings showed that Anodal tDCS applied bilaterally over the fronto-temporal cortex significantly improves (1) neuropsychiatric symptoms (as measured by the neuropsychiatric inventory, NPI) in FTD patients immediately after tDCS treatment, and (2) simple visual reaction times (sVRTs) up to 1 month after tDCS treatment. These cognitive improvements significantly correlate with the time course of the slow EEG oscillations (delta and theta bands) measured at the same time points. Even though further studies on larger samples are needed, these findings support the effectiveness of Anodal tDCS over the fronto-temporal regions in FTD on attentional processes that might be correlated to a normalized EEG low-frequency pattern.
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Affiliation(s)
- Roberta Ferrucci
- Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- “Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
- III Neurological Clinic, San Paolo Hospital, Milan, Italy
| | - Simona Mrakic-Sposta
- Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- National Council of Research, Institute of Bioimaging and Molecular Physiology, Segrate, Italy
| | - Simona Gardini
- Department of Neuroscience, University of Parma, Parma, Italy
| | - Fabiana Ruggiero
- Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Vergari
- Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Mameli
- Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Arighi
- Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” center, University of Milan, Milan, Italy
| | - Marco Spallazzi
- Dementia Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Federica Barocco
- Dementia Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | | | - Anna Margherita Pietroboni
- Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” center, University of Milan, Milan, Italy
| | - Laura Ghezzi
- Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” center, University of Milan, Milan, Italy
| | - Giorgio Giulio Fumagalli
- Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” center, University of Milan, Milan, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | | | - Paolo Caffarra
- Dementia Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
- Center for Cognitive Disorders and Dementia, AUSL of Parma, Parma, Italy
| | - Elio Scarpini
- Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” center, University of Milan, Milan, Italy
| | - Alberto Priori
- “Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
- III Neurological Clinic, San Paolo Hospital, Milan, Italy
| | - Sara Marceglia
- Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
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7
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Transcranial Direct Current Stimulation in the Acute Depressive Episode: A Systematic Review of Current Knowledge. J ECT 2018; 34:153-163. [PMID: 29901497 DOI: 10.1097/yct.0000000000000512] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Major depressive disorder is a severe, refractory mental disorder. Only one third of patients treated with antidepressants achieve remission after 3 trials, while subject to adverse effects. Therefore, the investigation of alternative treatments is paramount. The aim of this systematic review was to summarize the most recent evidence of transcranial direct current stimulation (tDCS) intervention for the acute phase of major depressive disorder. A PubMed search was performed including the terms "transcranial direct current stimulation" OR "transcranial direct stimulation" OR "tDCS" AND "major depressive disorder" OR "major depression" OR "depression" AND "trial." The search was conducted from inception until February 2018. Our search yielded initially 165 results, and 14 randomized clinical trials were included according to eligibility criteria. Most studies were pilot studies, with mixed findings. Two large randomized clinical trials recently published also presented primary negative findings. Study protocols usually used anodal left/cathodal right dorsolateral prefrontal cortex stimulation, 1 to 2.5 mA, and 5 to 20 tDCS sessions. We discuss the limitations of the included trials, such as sample and tDCS parameters heterogeneity between studies. To conclude, tDCS seems to be safe and devoid of serious adverse effects, although robust efficacy has not been consistently demonstrated in clinical trials assessing an acute treatment course of up to 4 weeks. Further directions are discussed, such as parameter individualization, investigation of biological markers, and home-use tDCS.
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8
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Transcranial Direct Current Stimulation (tDCS) for Depression during Pregnancy: Scientific Evidence and What Is Being Said in the Media-A Systematic Review. Brain Sci 2018; 8:brainsci8080155. [PMID: 30110930 PMCID: PMC6119899 DOI: 10.3390/brainsci8080155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 12/19/2022] Open
Abstract
Major depression is the most frequent morbidity in pregnancy. The first-line therapies, psychopharmacologic treatment and psychotherapy, are either insufficient or may cause severe or teratogenic adverse events. As a result of its local limitation to the patient’s brain, transcranial direct current stimulation (tDCS) could potentially be an ideal treatment for pregnant women with depression. A literature search was conducted in medical databases, globally published newspapers, search engines, and clinical trial registers to collect all articles on tDCS for the treatment of depression during pregnancy. The aim of this review was to investigate the scientific evidence of tDCS use for depression during pregnancy and to compare these results with the textual and emotional perception in the media as interventions during pregnancy are under particular surveillance. We detected 13 medical articles dealing with tDCS for depression in pregnancy. Overall, the scientific evidence as well as articles in the media for tDCS in pregnancy are sparse, but promising. Further studies are required in this specifically vulnerable population of pregnant women to generate evidence. It is likely that public interest will increase when the results of a pilot study in Canada are published.
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9
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Wang D, Yu Z, Yan J, Xue F, Ren G, Jiang C, Wang W, Piao Y, Yang X. Photolysis of Caged-GABA Rapidly Terminates Seizures In Vivo: Concentration and Light Intensity Dependence. Front Neurol 2017; 8:215. [PMID: 28572790 PMCID: PMC5435768 DOI: 10.3389/fneur.2017.00215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/02/2017] [Indexed: 02/05/2023] Open
Abstract
The therapy of focal epilepsy remains unsatisfactory for as many as 25% of patients. The photolysis of caged-γ-aminobutyric acid (caged-GABA) represents a novel and alternative option for the treatment of intractable epilepsy. Our previous experimental results have demonstrated that the use of blue light produced by light-emitting diode to uncage ruthenium-bipyridine-triphenylphosphine-c-GABA (RuBi-GABA) can rapidly terminate paroxysmal seizure activity both in vitro and in vivo. However, the optimal concentration of RuBi-GABA, and the intensity of illumination to abort seizures, remains unknown. The aim of this study was to explore the optimal anti-seizure effects of RuBi-GABA by using implantable fibers to introduce blue light into the neocortex of a 4-aminopyridine-induced acute seizure model in rats. We then investigated the effects of different combinations of RuBi-GABA concentrations and light intensity upon seizure. Our results show that the anti-seizure effect of RuBi-GABA has obvious concentration and light intensity dependence. This is the first example of using an implantable device for the photolysis of RuBi-GABA in the therapy of neocortical seizure, and an optimal combination of RuBi-GABA concentration and light intensity was explored. These results provide important experimental data for future clinical translational studies.
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Affiliation(s)
- Dan Wang
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China
| | - Zhixin Yu
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China
| | - Jiaqing Yan
- College of Electrical and Control Engineering, North China University of Technology, Beijing, China
| | - Fenqin Xue
- Core Facilities Center, Capital Medical University, Beijing, China
| | - Guoping Ren
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China
| | - Chenxi Jiang
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China
| | - Weimin Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yueshan Piao
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Yang
- Neuroelectrophysiological Laboratory, Xuanwu Hospital, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.,Center of Epilepsy, Center for Brain Disorders Research, Capital Medical University, Beijing, China
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10
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Felipe RDM, Ferrão YA. Transcranial magnetic stimulation for treatment of major depression during pregnancy: a review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2017; 38:190-197. [PMID: 28076639 DOI: 10.1590/2237-6089-2015-0076] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/16/2016] [Indexed: 02/26/2023]
Abstract
Introduction: Pregnancy is characterized by a high prevalence of mental disorders. Depression is the most common of these disorders and it is a risk factor for negative maternal and child development outcomes. Psychotherapy and pharmacotherapy are conventional and well-established therapeutic options, but some clients fail to respond and the safety of using some pharmacological agents during pregnancy is unclear. Some neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), have been studied in depressed pregnant women. Objective: To evaluate the safety and efficacy of rTMS for major depression in pregnant women. Methods: The LILACS and PubMed databases were reviewed using the search terms depression, pregnancy and magnetic stimulation. Texts including primary data, published in Portuguese, Spanish, or English, between 1995 and 2014, that evaluated depressed pregnant women and used rTMS as the intervention were selected. Papers lacking sufficient data were excluded. Twenty-two texts were initially identified; after applying the inclusion criteria, 12 were selected and analyzed. Results: The studies reviewed reported satisfactory responses to rTMS in acute depressive episodes, as measured using depressive symptom scales. Remission of symptoms was achieved in many cases. The procedure was well tolerated and there were no reports of damage/complications to unborn children. Conclusion: The data available at this time support the efficacy and tolerability of rTMS for depression in pregnant women. Controlled studies should corroborate this conclusion. This review only included studies in three languages and the resulting sample size was not large enough to conduct a meta-analysis.
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Affiliation(s)
- Renata de Melo Felipe
- Programa de Residência Médica em Psiquiatria, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ygor Arzeno Ferrão
- Departamento de Medicina Interna - Psiquiatria, UFCSPA, Porto Alegre, RS, Brazil
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Gschwind M, Seeck M. Transcranial direct-current stimulation as treatment in epilepsy. Expert Rev Neurother 2016; 16:1427-1441. [DOI: 10.1080/14737175.2016.1209410] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Brunoni AR, Sampaio-Junior B, Moffa AH, Borrione L, Nogueira BS, Aparício LVM, Veronezi B, Moreno M, Fernandes RA, Tavares D, Bueno PVS, Seibt O, Bikson M, Fraguas R, Benseñor IM. The Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS): rationale and study design of a non-inferiority, triple-arm, placebo-controlled clinical trial. SAO PAULO MED J 2015; 133:252-63. [PMID: 26176930 PMCID: PMC10876376 DOI: 10.1590/1516-3180.2014.00351712] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 11/24/2014] [Accepted: 12/17/2014] [Indexed: 12/28/2022] Open
Abstract
CONTEXT AND OBJECTIVE Major depressive disorder (MDD) is a common psychiatric condition, mostly treated with antidepressant drugs, which are limited due to refractoriness and adverse effects. We describe the study rationale and design of ELECT-TDCS (Escitalopram versus Electric Current Therapy for Treating Depression Clinical Study), which is investigating a non-pharmacological treatment known as transcranial direct current stimulation (tDCS). DESIGN AND SETTING Phase-III, randomized, non-inferiority, triple-arm, placebo-controlled study, ongoing in São Paulo, Brazil. METHODS ELECT-TDCS compares the efficacy of active tDCS/placebo pill, sham tDCS/escitalopram 20 mg/day and sham tDCS/placebo pill, for ten weeks, randomizing 240 patients in a 3:3:2 ratio, respectively. Our primary aim is to show that tDCS is not inferior to escitalopram with a non-inferiority margin of at least 50% of the escitalopram effect, in relation to placebo. As secondary aims, we investigate several biomarkers such as genetic polymorphisms, neurotrophin serum markers, motor cortical excitability, heart rate variability and neuroimaging. RESULTS Proving that tDCS is similarly effective to antidepressants would have a tremendous impact on clinical psychiatry, since tDCS is virtually devoid of adverse effects. Its ease of use, portability and low price are further compelling characteristics for its use in primary and secondary healthcare. Multimodal investigation of biomarkers will also contribute towards understanding the antidepressant mechanisms of action of tDCS. CONCLUSION Our results have the potential to introduce a novel technique to the therapeutic arsenal of treatments for depression.
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Affiliation(s)
- André Russowsky Brunoni
- MD, PhD. Attending Physician, Interdisciplinary Neuromodulation Service, Interdisciplinary Center for Applied Neuromodulation, Hospital Universitário (HU), and Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Universidade de São Paulo (USP), São Paulo, Brazil.
| | - Bernardo Sampaio-Junior
- MD. Interdisciplinary Neuromodulation Service, Interdisciplinary Center for Applied Neuromodulation, HU, and Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, USP, São Paulo, Brazil.
| | - Adriano Henrique Moffa
- BA, MSc. Interdisciplinary Center for Applied Neuromodulation, HU, USP, São Paulo, Brazil.
| | - Lucas Borrione
- MD, MSc. Interdisciplinary Center for Applied Neuromodulation, HU and Department and Institute of Psychiatry, USP, São Paulo, Brazil.
| | | | | | - Beatriz Veronezi
- Psychology Student, Interdisciplinary Center for Applied Neuromodulation, HU, USP, São Paulo, Brazil.
| | - Marina Moreno
- Psychology Student, Interdisciplinary Center for Applied Neuromodulation, HU, USP, São Paulo, Brazil.
| | - Raquel Albano Fernandes
- Psychology Student, Interdisciplinary Center for Applied Neuromodulation, HU, USP, São Paulo, Brazil.
| | - Diego Tavares
- MD. Medical Resident and Student, Interdisciplinary Neuromodulation Service, Interdisciplinary Center for Applied Neuromodulation, HU and Department and Institute of Psychiatry, USP, São Paulo, Brazil.
| | - Priscila Vilela Silveira Bueno
- MD. Medical Resident and Student, Interdisciplinary Neuromodulation Service, Interdisciplinary Center for Applied Neuromodulation, HU and Department and Institute of Psychiatry, USP, São Paulo, Brazil.
| | - Ole Seibt
- MSc. Researcher, Department of Biomedical Engineering, City College of City University of New York, New York, USA.
| | - Marom Bikson
- PhD. Head, Department of Biomedical Engineering, City College of City University of New York, New York, USA.
| | - Renerio Fraguas
- MD, PhD. Assistant Professor, HU and Department and Institute of Psychiatry, USP, São Paulo, Brazil.
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Liu B, Zhang Y, Zhang L, Li L. Repetitive transcranial magnetic stimulation as an augmentative strategy for treatment-resistant depression, a meta-analysis of randomized, double-blind and sham-controlled study. BMC Psychiatry 2014; 14:342. [PMID: 25433539 PMCID: PMC4264336 DOI: 10.1186/s12888-014-0342-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/18/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Dozens of randomized controlled trials (RCTs) and meta-analyses have demonstrated the efficacy of repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) treatment, but there has not been a meta-analysis report which evaluates the efficacy and tolerability of rTMS used as an augmentative strategy for antidepressants in treatment-resistant depression (TRD) treatment. We thus conducted this meta-analysis, aimed at clarifying whether rTMS enhances the efficacy of TRD. METHODS We searched MEDLINE and Cochrane Central Register of Controlled Trials for RCTs for studying the efficacy of rTMS versus (vs) sham condition when combined with antidepressants in TRD treatment, and screened the references of the previous meta-analysis about the rTMS for MDD treatment. Response rates and NNT were chose as the primary outcomes, and remission rates, change from baseline of HAMD scores, dropouts were used as secondary outcomes. For dichotomous data, an intention-to-treat analysis principle was applied; for continuous data, we calculated the standard mean difference between groups with a random-effect model. Sensitivity analysis was done to explore the source of heterogeneity and the factors which potentially impact the efficacy. RESULTS Seven RCTs were finally included in the meta-analysis. The total sample size was 279, with 171 in the rTMS group and 108 in the sham group. The pooled response and remission rate for the rTMS and sham group was 46.6% and 22.1%, respectively; the pooled odds ratio (OR) was 5.12 [95% confidence interval (CI) 2.11-12.45, z = 3.60, p = 0.0003, and the associated number needed to treat (NNT) was 3.4. rTMS group achieved a significant reduction of HAMD score than the sham group, the pooled SMD of change from baseline was 0.86 [95% confidence interval (CI) 0.57-1.15, z = 5.75, p < 0.00001]. Because of the small number of included RCTs, the preplanned sensitivity and subgroup analyses were finally abandoned. The dropouts in both groups were relatively low, indicating the high acceptability of rTMS. CONCLUSIONS For TRD patients, augmentative rTMS after the failure of medications significantly increases the effect of antidepressants, and rTMS was a safe strategy with relatively low adverse events and low dropout rate, suggesting that augmentative rTMS is an effective intervention for TRD.
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Affiliation(s)
- Bangshan Liu
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan China
| | - Yan Zhang
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan China
| | - Li Zhang
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan China
| | - Lingjiang Li
- Mental Health Institute of The Second Xiangya Hospital, National Technology Institute of Psychiatry,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, Hunan China ,Shenzhen Kangning Hospital of Guangdong Province, Shenzhen, Guangdong China
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