Treatment of Resistant Depression: A Pilot Study Assessing the Efficacy of a tDCS-Mindfulness Program Compared With a tDCS-Relaxation Program

Abstract

Background: This pilot study explores a therapeutic setting combining transcranial direct current stimulation (tDCS) and mindfulness-based cognitive therapy (MBCT) for patients with drug-resistant depression. tDCS has shown efficacy for depression treatment and improvement could be maintained with the combination with mindfulness, which has shown depression relapse-prevention properties.Methods: Thirty-one treatment-resistant depressed patients have been assigned to our experimental treatment condition [tDCS combined with MBCT (n = 15)] or to a control condition [tDCS combined with relaxation (n = 16)]. Patients have completed both an intensive treatment block (eight consecutive days) and a single remind session 2 weeks after the intensive treatment. Clinical (depression, anxiety, and rumination) and cognitive (general cognitive functioning, mental flexibility, and working memory) symptoms of depression have been assessed through different questionnaires at baseline (t0), after the first block of treatment (t1), and after the remind session (t2).Results: Results seem to indicate a positive impact of both treatment conditions on clinical and cognitive symptoms of depression at t1. However, the treatment condition combining tDCS with mindfulness has been found to better maintain clinical improvements at t2 regarding some clinical [Montgomery–Åsberg Depression Rating Scale (MADRS) and Sadness and Anger Ruminative Inventory (SARI)] and cognitive variables (Digit Span-F and Digit Span-B).Conclusion: Based on the current observations, a multi-disciplinary treatment approach combining tDCS and MBCT might be effective in resistant depressed patients in the long run, even though further clinical research is necessary.

Gut Microbiota and Bipolar Disorder: An Overview on a Novel Biomarker for Diagnosis and Treatment

“…By evaluating the evidence provided by clinical studies, specifically addressing patients with BD, it appears that the additional treatment with probiotics can improve cognitive and obsessive symptoms, as well as reduce manic exacerbations of the disorder [ 93 , 94 , 95 , 96 , 101 , 107 ]. In the same direction, the study by Aizawa et al highlighted a relationship between the counts of Bifidobacterium and Lactobacillus and depressive symptoms in bipolar patients, with an important correlation between the Lactobacillus count and the severity of insomnia; this offers the possibility of using probiotics based on lactobacilli for treatment of sleep disorders in this category of patients [ 64 ] and provide interesting evidence of how treatment with “psychobiotics” can have beneficial and ameliorative effects on various symptomatic aspects of BD.…”

“…Another study by Aizawa et al [ 64 ] examined the association between Bifidobacterium and Lactobacillus counts and affective symptoms in 39 BD patients with bipolar depression (BPD) (13 BD-I; 16 BD-II according to DSM-IV) and 58 HC. Depressive symptoms were assessed using the 17-item version of the HAM-D including the sleep subscale, while the YMRS was used to assess manic symptoms.…”

Precision non-implantable neuromodulation therapies: a perspective for the depressed brain

“…In an early, open-label study, Martin et al combined tDCS with a task designed to improve identification of emotional states, in treatment-resistant depressed participants, with positive results (41% of study completers displayed treatment response). 107 In another recent pilot study, 108 patients with treatment-resistant depression (TRD) received active tDCS (20 min, 2 mA, applied to the left DLPFC) on 8 consecutive days and were randomly assigned to receive either 2 hours of mindfulness-based cognitive therapy (MBCT) or a 30-minute relaxation session immediately after each tDCS session. Results indicate a longer lasting reduction of depressive symptoms and enhanced cognitive processes in patients receiving the tDCS/MBCT combination.…”

Mindfulness Enhances Cognitive Functioning: A Meta-Analysis of 111 Randomized Controlled Trials

“…MBI-teaching assessment criteria) (Crane et al, 2013;Crane et al, 2020). Therefore we excluded studies that used acceptance and commitment therapy (e.g., Hayes, Strosahl, & Wilson, 2011;Svanberg, Munck, & Levander, 2017), dialectical behavior therapy (e.g., Afshari, Omidi, & Ahmadvand, 2020;Linehan, 1993), integrative mind-body training (e.g., Lam et al, 2011;Tang et al, 2007;Walsh et al, 2015), loving kindness meditation (e.g., Wood, Roach, Kearney, & Zabek, 2018), neurofeedback mindfulness training (e.g., Balconi, Crivelli, & Angioletti, 2019;Bhayee et al, 2016;Monnart et al, 2019), mantra-based training (e.g., Rao, Metri, Raghuram, & Hongasandra, 2017, hatha yoga or mindfulness-oriented yoga (e.g., , self-compassion training (e.g., Haukaas, Gjerde, Varting, Hallan, & Solem, 2018;Neff & Germer, 2013), MBIs augmented with aromatherapy (e.g., Maynard, Solis, Miller, & Brendel, 2017) or a control condition that contained any form of MBI (e.g., Britton et al, 2018); and (3) control group did not include MBI components. Figure 1 presents the PRISMA flowchart that summarizes the search process and offers reasons for excluding studies.…”