Safety and acceptability of transcranial direct current stimulation for the acute treatment of major depressive episodes: Analysis of individual patient data

2017 ◽  
Vol 221 ◽  
pp. 1-5 ◽  
Author(s):  
Adriano H. Moffa ◽  
André R. Brunoni ◽  
Felipe Fregni ◽  
Ulrich Palm ◽  
Frank Padberg ◽  
...  
Keyword(s):  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Acute Treatment ◽  
Individual Patient Data ◽  
Patient Data ◽  
Major Depressive ◽  
Direct Current Stimulation ◽  
Major Depressive Episodes ◽  
Depressive Episodes

scholarly journals Transcranial direct current stimulation for acute major depressive episodes: Meta-analysis of individual patient data

2016 ◽  
Vol 208 (6) ◽  
pp. 522-531 ◽  
Author(s):  
André R. Brunoni ◽  
Adriano H. Moffa ◽  
Felipe Fregni ◽  
Ulrich Palm ◽  
Frank Padberg ◽  
...  
Keyword(s):  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Pharmacological Intervention ◽  
Individual Response ◽  
Direct Current Stimulation ◽  
Major Depressive Episodes ◽  
Depressive Episodes

BackgroundTranscranial direct current stimulation (tDCS) is a non-pharmacological intervention for depression. It has mixed results, possibly caused by study heterogeneity.AimsTo assess tDCS efficacy and to explore individual response predictors.MethodSystematic review and individual patient data meta-analysis.ResultsData were gathered from six randomised sham-controlled trials, enrolling 289 patients. Active tDCS was significantly superior to sham for response (34% v. 19% respectively, odds ratio (OR) = 2.44, 95% CI 1.38–4.32, number needed to treat (NNT) = 7), remission (23.1% v. 12.7% respectively, OR = 2.38, 95% CI 1.22–4.64, NNT = 9) and depression improvement (B coefficient 0.35, 95% CI 0.12–0.57). Mixed-effects models showed that, after adjustment for other predictors and confounders, treatment-resistant depression and higher tDCS ‘doses' were, respectively, negatively and positively associated with tDCS efficacy.ConclusionsThe effect size of tDCS treatment was comparable with those reported for repetitive transcranial magnetic stimulation and antidepressant drug treatment in primary care. The most important parameters for optimisation in future trials are depression refractoriness and tDCS dose.

scholarly journals Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of adult major depressive episodes: A systematic review and network meta-analysis of 113 randomised clinical trials

2018 ◽  
Author(s):  
Julian Mutz ◽  
Vijeinika Vipulananthan ◽  
Ben Carter ◽  
Rene Hurlemann ◽  
Cynthia H Y Fu ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Brain Stimulation ◽  
Acute Treatment ◽  
Meta Analysis ◽  
High Dose ◽  
Major Depressive ◽  
Treatment Protocols ◽  
Severity Scores ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Background: Non-surgical brain stimulation techniques have been applied as tertiary treatments in major depression. However, the relative efficacy and acceptability of individual protocols is uncertain. Our aim was to estimate the comparative clinical efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults. Methods: Embase, PubMed/MEDLINE and PsycINFO were searched up until May 8, 2018, supplemented by manual searches of bibliographies of recent reviews and included trials. We included clinical trials with random allocation to electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), accelerated TMS (aTMS), priming TMS (pTMS), deep TMS (dTMS), theta burst stimulation (TBS), synchronised TMS (sTMS), magnetic seizure therapy (MST) or transcranial direct current stimulation (tDCS) protocols or sham. Data were extracted from published reports and outcomes were synthesised using pairwise and network random-effects meta-analysis. Primary outcomes were response (efficacy) and all-cause discontinuation (acceptability). We computed odds ratios (OR) with 95% confidence intervals (CI). Remission and continuous post-treatment depression severity scores were also examined. Results: 113 trials (262 treatment arms) randomising 6,750 patients (mean age = 47.9 years; 59% female) with major depressive disorder or bipolar depression met our inclusion criteria. In terms of efficacy, 10 out of 18 treatment protocols were associated with higher response relative to sham in network meta-analysis: bitemporal ECT (OR=8.91, 95%CI 2.57-30.91), high-dose right-unilateral ECT (OR=7.27, 1.90-27.78), pTMS (OR=6.02, 2.21-16.38), MST (OR=5.55, 1.06-28.99), bilateral rTMS (OR=4.92, 2.93-8.25), bilateral TBS (OR=4.44, 1.47-13.41), low-frequency right rTMS (OR=3.65, 2.13-6.24), intermittent TBS (OR=3.20, 1.45-7.08), high-frequency left rTMS (OR=3.17, 2.29-4.37) and tDCS (OR=2.65, 1.55-4.55). Comparing active treatments, bitemporal ECT and high-dose right-unilateral ECT were associated with increased response. All treatment protocols were at least as acceptable as sham treatment. Conclusion: We found that non-surgical brain stimulation techniques constitute viable alternative or add-on treatments for adult patients with major depressive episodes. Our findings also highlight the need to consider other patient and treatment-related factors in addition to antidepressant efficacy and acceptability when making clinical decisions; and emphasize important research priorities in the field of brain stimulation.

Effects of Repeated Sessions of Transcranial Direct Current Stimulation on Major Depressive Disorder and Cognition

2019 ◽  
Vol 35 (3) ◽  
pp. e32-e33
Author(s):  
Marco Ninghetto ◽  
Roberto Gammeri ◽  
Roberta Miccolis ◽  
Marcello Nobili ◽  
Adriana Salatino ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Major Depressive ◽  
Direct Current Stimulation
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