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Interactions between transcranial direct current stimulation (tDCS) and pharmacological interventions in the Major Depressive Episode: Findings from a naturalistic study

Published online by Cambridge University Press:  15 April 2020

A.R. Brunoni ,
R. Ferrucci ,
M. Bortolomasi ,
E. Scelzo ,
P.S. Boggio ,
F. Fregni ,
B. Dell’Osso ,
M. Giacopuzzi ,
A.C. Altamura  and
A. Priori
A.R. Brunoni
Affiliation:
Clinical Research Center, University Hospital, University of Sao Paulo, Sao Paulo, Brazil
R. Ferrucci
Affiliation:
Fondazione IRCCS “Ca’ Granda” Ospedale Maggiore di Milano, Department of Medical-Surgical Pathophysiology and Transplants Section of Neurosciences, University of Milan, Milano, Italy
M. Bortolomasi
Affiliation:
Pychiatric Hospital “Villa Santa Chiara”, Verona, Italy
E. Scelzo
Affiliation:
Fondazione IRCCS “Ca’ Granda” Ospedale Maggiore di Milano, Department of Medical-Surgical Pathophysiology and Transplants Section of Neurosciences, University of Milan, Milano, Italy
P.S. Boggio
Affiliation:
Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
F. Fregni
Affiliation:
Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston (MA), USA
B. Dell’Osso
Affiliation:
Fondazione IRCCS “Ca’ Granda” Ospedale Maggiore di Milano, Department of Medical-Surgical Pathophysiology and Transplants Section of Neurosciences, University of Milan, Milano, Italy
M. Giacopuzzi
Affiliation:
Pychiatric Hospital “Villa Santa Chiara”, Verona, Italy
A.C. Altamura
Affiliation:
Fondazione IRCCS “Ca’ Granda” Ospedale Maggiore di Milano, Department of Medical-Surgical Pathophysiology and Transplants Section of Neurosciences, University of Milan, Milano, Italy
A. Priori*
Affiliation:
Fondazione IRCCS “Ca’ Granda” Ospedale Maggiore di Milano, Department of Medical-Surgical Pathophysiology and Transplants Section of Neurosciences, University of Milan, Milano, Italy
*
*Corresponding author. E-mail address:alberto.priori@unimi.it (A. Priori).
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Abstract

Background:

Transcranial direct current stimulation (tDCS) is a non-invasive, neuromodulatory technique with an emerging role for treating major depression.

Objective:

To investigate the interactions between tDCS and drug therapy in unipolar and bipolar depressed patients who were refractory for at least one pharmacological treatment.

Methods:

This was a naturalistic study using data from 54 female and 28 male patients (mean age of 54 years) that consecutively visited our psychiatric unit. They received active tDCS (five consecutive days, 2 mA, anodal stimulation over the left and cathodal over the right dorsolateral prefrontal cortex, twice a day, 20 minutes). The outcome variable (mood) was evaluated using the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS). Predictor variables were age, gender, disorder and pharmacological treatment (seven dummy variables). We performed univariate and multivariate analyses as to identify predictors associated to the outcome.

Results:

After 5 days of treatment, BDI and HDRS scores decreased significantly (29% ± 36%, 18% ± 9%, respectively, P < 0.01 for both). Benzodiazepine use was independently associated with a worse outcome in both univariate (β = 4.92, P < 0.01) and multivariate (β = 5.8, P < 0.01) analyses; whereas use of dual-reuptake inhibitors positively changed tDCS effects in the multivariate model (β = –4.7, P = 0.02). A similar trend was observed for tricyclics (β = –4, P = 0.06) but not for antipsychotics, non-benzodiazepine anticonvulsants and other drugs.

Conclusion:

tDCS over the DLPFC acutely improved depressive symptoms. Besides the inherent limitations of our naturalistic design, our results suggest that tDCS effects might vary according to prior pharmacological treatment, notably benzodiazepines and some antidepressant classes. This issue should be further explored in controlled studies.

Keywords

Major depressive disorderBipolar disorderTranscranial direct current stimulationBenzodiazepinesSerotonin uptake inhibitors
Type
Original article
Information
European Psychiatry , Volume 28 , Issue 6 , August 2013 , pp. 356 - 361
Copyright
Copyright © European Psychiatric Association

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