Abstract
The efficacy of high‐definition transcranial direct current stimulation (HD‐tDCS) in late‐life depression (LLD) remains unknown due to limited research on its therapeutic effects on the hallmarks of LLD—the depressive and cognitive symptoms. The present open‐label pilot study aimed to examine the effectiveness of HD‐tDCS as an augmentation therapy with antidepressants in improving the depressive and cognitive symptoms for LLD. Significant improvements were hypothesized in the depressive, cognitive, and daily functioning outcomes over time. A total of 15 subjects with LLD (13 females, mean age = 73.27 ± 6.25) received five consecutive daily sessions of 20‐minute active HD‐tDCS interventions weekly for 2 weeks, with a 2 mA anodal stimulation over F3 and cathodal stimulation over FC1, AF3, F7, and FC5. Depressive symptoms and cognitive and daily functioning were assessed across five assessment timepoints. The results revealed that the HD‐tDCS was effective in reducing the depressive severity and the remission rates, with a sustained effect at both the 1‐month and 3‐month follow‐up. Pre‐post improvements were seen in the overall cognitive functioning and in verbal fluency, but not in executive functioning. Our pilot study provides a preliminary result of HD‐tDCS in LLD, which was a safe and effective treatment in alleviating depressive symptoms, with mild cognitive improvements observed. Further larger scale randomized controlled trials are needed to confirm this result.
Highlights
| INTRODUCTIONLate‐life depression (LLD) is one of the costliest global health issues, with a prevalence rate of up to 16%.1 Distinctive from adult‐onset de‐ pression, patients with LLD often experience a longer recovery time and receive a less favorable prognosis due to frequent relapses and re‐ sidual symptoms.[2]
Serotonin deficits and asymmetrical neural activities in the dorsal lat‐ eral prefrontal cortex (DLPFC) are two key neurological abnormalities in depression. transcranial direct current stimulation (tDCS) and serotonin are known to enhance one another's functions. tDCS increases the release of serotonin, mediated by sero‐ tonin transporters,[24] while a continuous enhancement of serotonin
We aimed to perform an open‐label pilot study to exam‐ ine the effectiveness of high‐definition transcranial direct current stimulation (HD‐tDCS) as an augmentation therapy with antidepressants in improving depressive and cognitive symptoms in patients with LLD
Summary
Late‐life depression (LLD) is one of the costliest global health issues, with a prevalence rate of up to 16%.1 Distinctive from adult‐onset de‐ pression, patients with LLD often experience a longer recovery time and receive a less favorable prognosis due to frequent relapses and re‐ sidual symptoms.[2]. People with LLD may not return to normal levels of performance, with respect to memory and executive functions, despite remission of depressive symptoms after antidepressant treatments.[14]. Those with memory impairments were more susceptible to developing dementia relative to those without memory deficits.[15]. One such approach is transcranial direct current stimulation (tDCS). Anodal stimulation over the left prefrontal cortex in schizophrenia patients showed an improvement in the functional capacity and depressive symptoms.[30] This lends support for tDCS's treatment potential for those with LLD as a monotherapy or augmentation with antidepressants. Serotonin deficits and asymmetrical neural activities in the dorsal lat‐ eral prefrontal cortex (DLPFC) (ie, hypoactivity and hyperactivity in the left and right DLPFC23) are two key neurological abnormalities in depression. tDCS and serotonin are known to enhance one another's functions. tDCS increases the release of serotonin, mediated by sero‐ tonin transporters,[24] while a continuous enhancement of serotonin
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