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

Rémi Moirand,Gabrielle Chesnoy,Benoit Bediou,Laetitia Imbert,Frédéric Haesebaert,Jérôme Brunelin,Emmanuel Poulet

doi:10.3390/jcm11030782

Abstract

Although transcranial Direct Current stimulation (tDCS) shows promise in the treatment of major depressive episodes, the optimal parameters and population to target remain unclear. We investigated the clinical interest of a 10 session tDCS regimen in patients with mild to severe treatment-resistant depression, in a pilot double-blind, randomized sham-controlled trial. tDCS was delivered over 5 consecutive days (two 30 min sessions per day separated by at least 2 h, 2 mA). The anode and cathode were placed over the left and the right dorsolateral prefrontal cortex, respectively. One month after tDCS, we observed significantly fewer patients who achieved remission (MADRS10 < 10) in the sham group (0 out of 18 patients) than in the active group (5 out of 21 patients; p = 0.05). However, no significant difference was observed between the groups regarding the mean scores of severity changes throughout the study period. Bifrontal add-on tDCS delivered twice per day over 5 days, in combination with antidepressant medication, can be a safe and suitable approach to achieve remission in patients with mild to severe treatment-resistant major depressive disorder. However, in regards to the pilot nature and limitations of the present study, further studies are needed before any frank conclusions can be made regarding the use of tDCS with the proposed parameters in clinical settings.

Highlights

Major depressive disorder (MDD) is a severe and frequent psychiatric condition associated with high disturbance in social functioning; in 2017, the WHO ranked major depression as the third cause of the burden of disease worldwide and projected that the disease will rank first by 2030 [1]
Recent evidence-based guidelines for the use of transcranial Direct Current stimulation (tDCS) in neurological and psychiatric disorders have concluded on the probable efficacy of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC), coupled with cathodal tDCS over the right supraorbital region in non-treatment-resistant MDD [4]
Recent studies with higher statistical power have proposed the use of a bifrontal montage, with the anode over the left DLPFC coupled with the cathode over the right DLPFC (e.g., [6])

Summary

Introduction

Major depressive disorder (MDD) is a severe and frequent psychiatric condition associated with high disturbance in social functioning; in 2017, the WHO ranked major depression as the third cause of the burden of disease worldwide and projected that the disease will rank first by 2030 [1]. Recent evidence-based guidelines for the use of tDCS in neurological and psychiatric disorders have concluded on the probable efficacy of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC), coupled with cathodal tDCS over the right supraorbital region in non-treatment-resistant MDD [4]. Recent studies with higher statistical power have proposed the use of a bifrontal montage, with the anode over the left DLPFC coupled with the cathode over the right DLPFC (e.g., [6]) These studies reported promising clinical results and led recent guidelines to consider tDCS as definitely effective in depression [7], without identifying the optimal parameters to apply (e.g., the electrode montage, the total number of sessions, the number of sessions per day, etc.) and the clinical characteristics of the patients who could benefit from such a therapeutic intervention

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