Efficacy and Safety of Transcranial Direct Current Stimulation as an Add-on Treatment for Bipolar Depression

Sampaio-Júnior, Bernardo; Tortella, Gabriel; Borrione, Lucas; Moffa, Adriano H.; Machado‐Vieira, Rodrigo; Cretaz, Eric; Silva, Adriano Fernandes da; Fráguas, Renério; Aparicio, Luana V Marotti; Klein, Izio; Lafer, Beny; Goerigk, Stephan; Benseñor, Isabela M.; Lotufo, Paulo A; Gattaz, Wagner F.; Brunoni, André R.

doi:10.1001/jamapsychiatry.2017.4040

Cited by 114 publications

(72 citation statements)

References 47 publications

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“…The interventions were 12 tDCS sessions or sham (10 sessions once a day for 2 weeks and then one session every other week until week 6). The main outcome was that active tDCS was superior to sham (Sampaio‐Junior et al., ).…”

Section: Methodsmentioning

confidence: 99%

“…Participants were recruited and enrolled as described in previously published studies ELECT‐TDCS (Brunoni et al., ) and BETTER (Sampaio‐Junior et al., ).…”

Section: Methodsmentioning

confidence: 99%

“…In BETTER, patients were aged between 18 and 65 years old and had been diagnosed with type I or II bipolar disorder in an acute depressive episode. Participants were in a stable drug regimen for at least 2 and 4 weeks for mood stabilizers and antidepressant drugs, respectively (Sampaio‐Junior et al., ).…”

Section: Methodsmentioning

confidence: 99%

“…Considering the importance of the maintenance phase of the depressive episode, it is critical to better explore tDCS regimens that could induce greater efficacy. We report the relapse rates of a 6‐month follow‐up data from our two randomized clinical trials that examined tDCS efficacy for unipolar (Brunoni et al., ) and bipolar (Sampaio‐Junior et al., ) depression. All patients were tDCS responders at follow‐up onset and underwent tDCS twice a week for 6 months.…”

Section: Introductionmentioning

confidence: 99%

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Transcranial direct current stimulation (tDCS) for preventing major depressive disorder relapse: Results of a 6-month follow-up

et al. 2019

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Background The efficacy of transcranial direct current stimulation (tDCS) as a continuation therapy for the maintenance phase of the depressive episode is low and insufficiently investigated in literature. We investigated whether it could be enhanced by using a more intensive treatment regimen compared to previous reports. Methods Twenty‐four patients (16 with unipolar depression and eight with bipolar depression) who presented acute tDCS response (≥50% depression improvement in the Hamilton Depression Rating Scale [HDRS]) after receiving 15 tDCS sessions were followed for up to 6 months or until relapse, defined as clinical worsening and/or HDRS > 15. Sessions were performed twice a week (maximum of 48 sessions) over 24 weeks. The anode and the cathode were positioned over the left and right dorsolateral prefrontal cortex (2 mA current, 30 min sessions were delivered). We performed Kaplan–Meier survival analysis and Cox proportional hazards ratios to evaluate predictors of relapse. Results Out of 24 patients, 18 completed the follow‐up period. tDCS treatment was well tolerated. The mean survival duration was 17.5 weeks (122 days). The survival rate at the end of follow‐up was 73.5% (95% confidence interval, 50–87). A trend (P = 0.09) was observed for lower relapse rates in nontreatment‐ vs. antidepressant treatment‐resistant patients (7.7% vs. 45.5%, respectively). No differences in efficacy between unipolar and bipolar depression were observed. Conclusion An intensive tDCS treatment regimen consisting of sessions twice a week achieved relatively low relapse rates after a 6‐month follow up of tDCS responders, particularly for nontreatment‐resistant patients.

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Section: Methodsmentioning

confidence: 99%

“…Participants were recruited and enrolled as described in previously published studies ELECT‐TDCS (Brunoni et al., ) and BETTER (Sampaio‐Junior et al., ).…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transcranial direct current stimulation (tDCS) for preventing major depressive disorder relapse: Results of a 6-month follow-up

et al. 2019

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“…1 Recently, a meta-analysis suggested that tDCS could also be a potential and well-tolerated therapeutic option for patients with bipolar disorder (BD) experiencing a major depressive episode (MDE) for which standard treatments are often inefficient and/or associated with a risk of manic switch. 2,3 We report here the case of a patient with a history of bipolar depression, with a severe intolerance to medications in the context of a comorbid spinocerebellar ataxia (SCA), who achieved full symptomatic recovery after being treated with tDCS over a 2-week protocol (Figure 1). Mrs R is a 70-year-old patient who fulfilled the DSM-5 diagnostic criteria for type I BD and consulted our Psychiatry Department for a treatment-resistant MDE (Montgomery-Asberg Depression Rating Scale (MADRS) = 38/60).…”

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confidence: 99%

Efficacy of tDCS for bipolar depression in a patient with spinocerebellar ataxia: A case report

Granon

Bénard

Devos³

et al. 2020

Bipolar Disorders

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Transcranial direct current stimulation (tDCS) is a safe non-pharmacological and non-invasive technique consisting of administering direct, weak electric currents into the brain using electrodes placed on the scalp to induce neuroplasticity and modulate cortical function beyond the period of stimulation. tDCS recently appeared as an experimental treatment for various neuropsychiatric conditions including major depressive disorder. 1 Recently, a meta-analysis suggested that tDCS could also be a potential and well-tolerated therapeutic option for patients with bipolar disorder (BD) experiencing a major depressive episode (MDE) for which standard treatments are often inefficient and/or associated with a risk of manic switch. 2,3 We report here the case of a patient with a history of bipolar depression, with a severe intolerance to medications in the context of a comorbid spinocerebellar ataxia (SCA), who achieved full symptomatic recovery after being treated with tDCS over a 2-week protocol (Figure 1). Mrs R is a 70-year-old patient who fulfilled the DSM-5 diagnostic criteria for type I BD and consulted our Psychiatry Department for a treatment-resistant MDE (Montgomery-Asberg Depression Rating Scale (MADRS) = 38/60). Informed consent was obtained from the patient for publication of this case report. The diagnosis of type I BD was based on a manic episode in 1990 (Young Mania Rating Scale (YMRS) >25) as well as multiple MDEs. Mrs R was also suffering from a SCA, diagnosed in 2009 after the apparition and the progressive worsening of cerebellar symptoms including cerebellar ataxia at lower and upper limbs, dysarthria, dysgraphia, hypotonia, and nystagmus. No cause for sporadic cerebellar ataxia and no familial history of SCA were found. The most frequent gene mutations (SCA1, 2, 3, 6, Friedreich ataxia) have been ruled out and standard blood tests were normal. The molecular diagnosis is currently in progress.Mrs R. has been treated over the past 15 years with a variety of pharmacological treatment, mainly selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) in monotherapy or in association with different class of mood stabilizers such as aripiprazole, valproic acid, lithium, or lamotrigine. The patient described a worsening of SCA symptoms following either the introduction or increase in the dose of all these mood stabilizers. When we met her, she had stopped all pharmacological treatments. Considering the patient preference, we first tried to carefully reintroduce lamotrigine in association with venlafaxine but each increase in lamotrigine dose was associated with a worsening of ataxia. Because of BD, we did not want to simply increase the venlafaxine dose without any efficient concurrent mood stabilizer due to the risk of antidepressant-induced mania. We tried multiple pharmacological adjustments based on these two medications over an 18-month period, but the patient kept suffering from MDE, sometimes associated with suicidal thoughts, with a MADRS score over 20/60. ...

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Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders

Sabé,

Hyde,

Cramer

et al. 2024

JAMA Netw Open

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ImportanceNoninvasive 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.ObjectiveTo define NIBS dose stimulation parameters associated with the greatest efficacy in symptom improvement across mental disorders.Data SourcesStudies were drawn from an updated (to April 30, 2023) previous systematic review based on a search of PubMed, OVID, and Web of Knowledge.Study SelectionRandomized 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 SynthesisTwo 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 MeasuresThe main outcome was the near-maximal effective doses of total pulses received for TMS and total current dose in coulombs for tDCS.ResultsA 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 &lt; .001); (2) in depression, HF-DLPFC TMS (χ2 = 14.49; df = 2; P &lt; .001); (3) in treatment-resistant depression, LDLPFC tDCS (χ2 = 14.56; df = 2; P &lt; .001); and (4) in substance use disorder, LDLPFC tDCS (χ2 = 33.63; df = 2; P &lt; .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 &lt; .001) and LF TMS on the orbitofrontal cortex with a plateaued curve (χ2 = 15.19; df = 2; P &lt; .001); and (4) in posttraumatic stress disorder, LF-RDLPFC TMS with ascending curve (χ2 = 54.15; df = 2; P &lt; .001). Sensitivity analyses confirmed the main findings.Conclusions and RelevanceThe 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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Efficacy and Safety of Transcranial Direct Current Stimulation as an Add-on Treatment for Bipolar Depression

Abstract: clinicaltrials.gov Identifier: NCT02152878.

Cited by 114 publications

References 47 publications

Transcranial direct current stimulation (tDCS) for preventing major depressive disorder relapse: Results of a 6-month follow-up

Transcranial direct current stimulation (tDCS) for preventing major depressive disorder relapse: Results of a 6-month follow-up

Efficacy of tDCS for bipolar depression in a patient with spinocerebellar ataxia: A case report

Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders

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