Bifrontal-transcranial direct current stimulation as an early augmentation strategy in major depressive disorder: A single-blind randomised controlled trial

Kumari, Babli; Singh, Amit; Kar, Sujita Kumar; Ahuja, Vivek

doi:10.1016/j.ajp.2023.103637

Cited by 8 publications

(13 citation statements)

References 36 publications

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“…Of the studies, only eight [ 15 , 16 , 21 , 29 , 32 – 34 , 37 ] provided clear descriptions of the methods employed for randomization and allocation concealment. Eleven studies [ 15 , 16 , 29 , 30 , 33 , 34 , 37 , 39 – 42 ] reported loss of follow-up, with the rate of incomplete data ranging from 3.0% to 35%. The primary reasons for losses to follow-up typically included patient mortality, intolerable pain, and refusal to persist with the intervention.…”

Section: Resultsmentioning

confidence: 99%

“…The primary reasons for losses to follow-up typically included patient mortality, intolerable pain, and refusal to persist with the intervention. Seven studies [ 15 , 16 , 29 , 32 – 34 , 37 ] were at low risk of reporting bias, and the study protocol of these studies could be retrieved. A summary of this is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Twelve studies [ 15 , 16 , 21 , 30 , 31 , 33 , 35 , 37 , 39 , 40 , 42 , 43 ] (seven rTMS and five tDCS) reported response rates (Fig. 6 ).…”

Section: Resultsmentioning

confidence: 99%

“…As shown in Fig. 9 , three RCTs [ 15 , 36 , 37 ] reported depression scores two weeks after intervention [SMD = -0.66, 95%CI (-1.40, 0.09), I 2 = 80.0%, p = 0.05], and two RCTs [ 39 , 41 ] reported depression scores three weeks after intervention [SMD = -1.25, 95%CI (-3.80, 1.30), I 2 = 98.0%, p > 0.05]. One RCT [ 16 ] reported depression scores at three months and six months after intervention [SMD = -0.07, 95%CI (-0.39, 0.25), p > 0.05] and [SMD = -0.32, 95%CI (-0.01, 0.64), p > 0.05], respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Currently, the efficacy of NIBS in combination with antidepressants remains controversial. It was reported [ 15 ] that the outcome of active tDCS treatment was preferable to that of sham treatment in a study with 43 MDD patients. In contrast, Burkhardt’s study [ 16 ], a recent randomised controlled trial (RCT) published in Lancet , reached the opposite: there was no intergroup difference in the mean improvement in depression scores between active and sham stimulations.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of non-invasive brain stimulation combined with antidepressant medications for depression: a systematic review and meta-analysis of randomized controlled trials

Tao,

Liang,

Zhang

et al. 2024

Syst Rev

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Background Antidepressants, noninvasive brain stimulation (NIBS), and their combination are commonly used in routine clinical practice. Nevertheless, there is a continuous dispute regarding whether the effectiveness of NIBS in combination with antidepressants exceeds that of antidepressants alone. This meta-analysis aimed to evaluate the existing evidence and draw a definitive conclusion on this issue. Methods We conducted a comprehensive search of five databases: Embase, PubMed, Web of Science, SinoMed, and the Cochrane Database of Randomized Controlled Trials. The search was conducted until October 6, 2023. The primary outcomes were the pre- and post-intervention depression and anxiety scores. Secondary outcomes included dropout rates, response rates, and certain levels of neurotransmitters [ 5-hydroxytryptamine (5-HT), dopamine (DA), and gamma-aminobutyric acid (GABA)] at the end of the intervention. Subgroup, meta-regression, and sensitivity analyses were performed to explore the sources of heterogeneity. The data were analysed using R 4.2.2. Results We included 18 RCTs [1357 participants; 11 studies used repetitive transcranial magnetic stimulation (rTMS) and 7 studies used transcranial direct current stimulation (tDCS)]. The follow-up duration varied from two weeks to three months. Overall, whether in combination with rTMS or tDCS, antidepressants proved more effective in alleviating depressive symptoms compared to when used as monotherapy. However, this advantage was not evident during the follow-up period. (p > 0.05). And the combination's efficacy in improving anxiety was found to be lacking. Post-treatment serum levels of 5-HT, DA, and GABA were higher in the rTMS group were higher than antidepressant medication group (p < 0.05). Furthermore, subgroup analysis results indicated that only the rTMS + antidepressant medication treatment significantly improved remission and remission rates. The meta-regression results showed that the type of antidepressant and the sex of the participants had a significant association with the depression score. Conclusion Combination treatment with NIBS was significantly more effective in improving depression symptoms than medication alone. rTMS combined with antidepressants appears to be more effective in improving response and remission rates. However, efficacy may be influenced by the type of medicine used in combination, and long-term efficacy data is lacking. Systematic review registration PROSPERO CRD42023388259.

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