Transcranial direct current stimulation: A novel approach in the treatment of vascular depression

Abstract

Background: Despite the impact of depression in terms of personal suffering and socioeconomic burden, most currently available treatment options are often ineffective. A particularly difficult-to-treat depressive disorder characteristic of the elderly is vascular depression, a late-life depressive syndrome related to a variety of potential vascular mechanisms. Transcranial Direct Current Stimulation (tDCS), a non-invasive and effective somatic approach to depression, also showed positive effects on cognitive deficits. Aim: We performed a double-blind randomized study to investigate the efficacy of tDCS as augmentation strategy to sertraline in the treatment of vascular depression, hypothesizing a positive effect in both depressive symptoms and cognitive functions. Methods: We enrolled 93 inpatients over 60 years of age with a diagnosis of vascular depression. Depressive symptoms were weekly assessed (T0, T1, T2) with the 21-items Hamilton depression rating scale (HDRS). Cognitive functioning was evaluated with the Milan Overall Dementia Assessment (MODA) at baseline and after the treatment protocol. All patients were randomly assigned into three groups, Group I: one tDCS stimulation per day, Group II: two tDCS stimulations per day, Sham group: one sham tDCS stimulation per day. Stimulation was performed for 10 consecutive working days. Results: A significant interaction time*treatment was observed on HDRS scores (F ¼ 14, p < 0.001). All groups improved at T1 but whereas Group II significantly differed from the Sham group (p < 0.001) we observed no difference between Sham and Group I. At T2 all groups improved but Group II showed the greater improvement (vs. Sham p < 0.001; vs. Group I p < 0.001) and the Sham group the smallest (vs. Group I p ¼ 0.005). A significant interaction time*treatment was also observed on MODA scores (F ¼ 3.31, p ¼ 0.04). Only subjects treated with tDCS improved at T2 (Group I: p < 0.001; Group II: p ¼ 0.007). However, no difference between Group I and II was shown. Conclusion: tDCS as augmentation treatment of an adequate pharmacotherapy is a potential strategy in the management of vascular depression, a disease known to be often unresponsive to antidepressants only. Non-invasiveness, the absence of severe side effects and the possibility of administering it to outpatients at an affordable price make tDCS an important tool in clinical practice.

Ten Sessions of 30 Min tDCS over 5 Days to Achieve Remission in Depression: A Randomized Pilot Study

“…The present results may also support the clinical interest of delivering two sessions of tDCS per day to achieve remission. This is in line with previous studies with comparable sample sizes, also reporting the beneficial effects of tDCS with two 30 min sessions per day, in a case-series of six patients with depressive disorders [9], six drug free patients with depression during pregnancy [20], and in a sample of 93 elderly participants [10]. The results are also consistent with studies reporting a beneficial effect of two 20 min sessions per day in 31 patients with depression (e.g., [21]), as well as in 30 patients with schizophrenia [22].…”

“…Delivering 10 sessions with two 30 min sessions per day over 5 days [9] instead of delivering the more common protocol with one daily session delivered over 2 weeks, has numerous benefits for clinical settings and decreases the global cost of the intervention. Moreover, although there is no clear evidence in unipolar depression, it has been reported that delivering two daily sessions is a safe intervention and may induce better clinical benefits than the protocol with one single daily session, in patients with vascular depression [10].…”

Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation

“…The nature of the induced cortical lesion depends on the electrode pole: the anode depolarizes the cell membrane of neurons, thereby enhancing the activity of the neural cortex. On the other hand, cathodic stimulation causes hyperpolarization of the cell membrane of neurons, leading to a decrease in cortical excitation [103,111]. In the subacute phase of a stroke, increased activation of the contralateral hemisphere and hypoactivation of the damaged hemisphere are observed.…”

Domiciliary tDCS in Geriatric Psychiatric Disorders: Opportunities and Challenges

“…A recent study has indicated the effectiveness of tDCS in treatment-resistant vascular depression. 21 There are also reports of tDCS as a potential intervention for apathy, insomnia, alcohol dependence, etc. [22][23][24] Hence tDCS can be a potentially useful intervention for older adults with neuropsychiatric conditions.…”