Transcranial direct current stimulation in a patient with therapy-resistant major depression

Abstract

Transcranial direct current stimulation (tDCS) of the prefrontal cortex (PFC) has been reported to exert significant antidepressant effects in patients with major depression. Several recent studies found an improvement of depressive symptoms in drug-free patients. Here we report the case of a 66-year-old female patient suffering from recurrent major depressive episodes who underwent anodal tDCS of the left dorsolateral PFC over 4 weeks as an add-on treatment to a stable antidepressant medication. Only a modest improvement of depressive symptoms was observed after tDCS, i.e. reduction of the baseline scores in the Hamilton Depression Rating Scale from 23 to 19 and in the Beck Depression Inventory from 27 to 20. However, there was an increase from 52 to 90% in the Regensburg Verbal Fluency Test. In addition, EEG was used to assess the acute effects of tDCS. Low resolution brain electromagnetic tomography (LORETA) showed a left unilateral focal effect (25-40% reduced power) in the delta, theta and alpha frequency bands. The same effect appeared in the surface analysis of the EEG. The absolute, as well as the relative power decreased significantly in the delta, theta and alpha bands after a comparison of the spectral analysis. Though tDCS over 4 weeks did not exert clinically meaningful antidepressant effects in this case of therapy-resistant depression, the findings for cognitive measures and EEG suggest that beneficial effects may occur in depressed subjects and future studies need to further explore this approach also in therapy-resistant major depression.

Neuromodulation Therapies for Geriatric Depression

“…Palm et al [115] found improvement on the Hamilton Depression Rating Scale (HDRS) of 16 % with 1 mA tDCS and 25 % with 2 mA tDCS in a subsample of 14 geriatric patients (mean age 68.22 years, range [61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79] although this is in line with findings from their larger study sample. Palm et al [116] also reported a case study of a 66-year-old female, who had no mood improvements after a course of tDCS but nonetheless showed improvements in verbal fluency (1 mA, 20 min, 16 sessions over 27 days).…”

La stimulation transcrânienne à courant continu (tDCS) dans la dépression : bilan de près d’une décennie de recherche clinique

“…Depuis cette date, 10 études cliniques randomisées et contrôlées par placebo [12,13,[19][20][21][22][23][24][25][26] (Tableau 1), 8 études ouvertes [27][28][29][30][31][32][33][34] (Tableau 2) et 6 cas cliniques [35][36][37][38][39][40] ont été publiés. Les patients inclus variaient beaucoup en fonction des traitements médicamenteux associés, de la résistance au traitement ou du caractère uni-ou bipolaire de la dépres-sion.…”

“…Cependant, d'autres études n'ont pas retrouvé ce type d'améliorations [22][23][24]27,30]. Par ailleurs, quelques cas cliniques d'amélioration de la fluence verbale après traitement par tDCS ont été rapportés dans des contextes de dépression résistante [35] ou post-accident vasculaire céré-bral [39].…”

Novel neurotherapeutics in psychiatry: use and rationale of transcranial direct current stimulation in major depressive disorder

“…The available case reports for tDCS in depression fall into three scenarios: (1) report of emergent hypomanic/manic symptoms following tDCS [46][47][48][49] ; (2) description of tDCS use in a specific type of depression (post-stroke depression) 50 and (3) evaluation of clinical symptoms and EEG findings in a patients with treatment-resistant depression 51 (Table 3).…”