Skip to main content
    • Aa
    • Aa

Augmentative transcranial direct current stimulation (tDCS) in poor responder depressed patients: a follow-up study

  • Bernardo Dell'Osso (a1), Cristina Dobrea (a1), Chiara Arici (a1), Beatrice Benatti (a1), Roberta Ferrucci (a2), Maurizio Vergari (a2), Alberto Priori (a2) and A. Carlo Altamura (a1)...

Transcranial direct current stimulation (tDCS) is a non-invasive neurostimulation technique that has received increasing interest in the area of mood disorders over the last several years. While acute, double-blind, sham-controlled studies have already reported positive findings in terms of efficacy and safety for tDCS, follow-up data are lacking. This need prompted the present follow-up study, which assesses post-acute effects of tDCS (no maintenance stimulation was performed), in the mid-term, in a sample of major depressives.


After completing an acute, open trial of tDCS, 23 outpatients with either major depressive disorder or bipolar disorder entered a naturalistic follow-up (T1) with clinical evaluations at one week (T2), 1 month (T3), and 3 months (T4). A quantitative analysis of Hamilton Depression Rating Scale (HAM-D), Montgomery–Asberg Depression Rating Scale (MADRS), and Young Mania Rating Scale (YMRS) total scores, through repeated measures analysis of variance (ANOVA) (T1–T4) and paired t-test for comparing specific time points (T1–T2, T2–T3, and T3–T4), was performed. In addition, a qualitative analysis on the basis of treatment response and remission (HAM-D) was performed.


Even though a progressive reduction of follow-up completers was observed from T2 to T4 (95.6% at T2, 65.2% at T3, and 47.8% at T4), the antidepressant effects of acute tDCS persisted over 3 months in almost half of the sample. Of note, no post-acute side effects emerged during the follow-up observation. The most frequent causes of drop-out from this study included major modifications in therapeutic regimen (30%) and poor adherence to follow-up visits (17%).


In this mid-term, open, follow-up study, tDCS showed mixed results. Further controlled studies are urgently needed to assess its effects beyond the acute phase.

Corresponding author
*Address for correspondence: Dr. Bernardo Dell'Osso, MD, Assistant Professor of Psychiatry, Department of Psychiatry, University of Milan; Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy. (Email
Hide All

The authors thank Dr. Filippo Castellano, MD, and Dr. Massimiliano Buoli, MD, for their support.

Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

6. SH Kennedy , R Milev , P Giacobbe , etal. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. IV. Neurostimulation therapies. J Affect Disord. 2009; 117(suppl. 1): S44S53.

7. F Fregni , PS Boggio , MA Nitsche , etal. Treatment of major depression with transcranial direct current stimulation. Bipolar Disord. 2006; 8: 203204.

8. PS Boggio , SP Rigonatti , RB Ribeiro , etal. A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Int J Neuropsychopharmacol. 2008; 11: 249254.

9. SP Rigonatti , PS Boggio , ML Myczkowski , etal. Transcranial direct stimulation and fluoxetine for the treatment of depression. Eur Psychiatry. 2008; 23: 7476.

10. R Ferrucci , M Bortolomasi , M Vergari , etal. Transcranial direct current stimulation in severe, drug-resistant major depression. J Affect Disord. 2009; 118: 215219.

11. CK Loo , P Sachdev , D Martin , etal. A double-blind, sham-controlled trial of transcranial direct current stimulation for the treatment of depression. Int J Neuropsychopharmacol. 2010; 13: 6169.

12. AR Brunoni , R Ferrucci , M Bortolomasi , etal. Transcranial direct current stimulation (tDCS) in unipolar vs. bipolar depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2011; 35: 96101.

13. DM Blumberger , LC Tran , PB Fitgerald , KE Hoy , ZJ Daskalakis . A randomized double-blind sham-controlled study of transcranial direct current stimulation for treatment-resistant major depression. Front Psychiatry. 2012; 3: 74.

14. CK Loo , A Alonzo , D Martin , etal. Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial. Br J Psychiatry. 2012; 200: 5259.

15. U Palm , C Schiller , Z Fintescu , etal. Transcranial direct current stimultation in treatment resistant depression: a randomized double-blind, placebo-controlled study. Brain Stimul. 2012; 5(3): 242251.

16. MA Nitsche , W Paulus . Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000; 527: 633639.

17. MA Nitsche , W Paulus . Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology. 2001; 57: 18991901.

18. S Grimm , J Beck , D Schuepbach , etal. Imbalance between left and right dorsolateral prefrontal cortex in major depression is linked to negative emotional judgment: an fMRI study in severe major depressive disorder. Biol Psychiatry. 2008; 63: 369376.

19. B Dell'Osso , S Zanoni , R Ferrucci , etal. Transcranial direct current stimulation for the outpatient treatment of poor-responder depressed patients. Eur Psychiatry. 2012; 27(7): 513517.

20. B Dell'Osso , A Priori , AC Altamura . Efficacy and safety of transcranial direct current stimulation in major depression. Biol Psychiatry. 2011; 69: e2324.

21. G Ardolino , B Bossi , S Barbieri , A Priori . Non-synaptic mechanisms underlie the after-effects of cathodal transcutaneous direct current stimulation of the human brain. J Physiol. 2005; 568: 653663.

22. D Liebetanz , F Fregni , KK Monte-Silva , etal. After-effects of transcranial direct current stimulation (tDCS) on cortical spreading depression. Neurosci Lett. 2006; 398: 8590.

24. AR Brunoni , L Valiengo , A Baccaro , etal. The sertraline vs. electrical current therapy for treating depression clinical study: results from a factorial, randomized, controlled trial. JAMA Psychiatry. 2013; 70(4): 383391.

25. DM Martin , A Alonzo , KA Ho , etal. Continuation transcranial direct current stimulation for the prevention of relapse in major depression. J Affect Disord. 2013; 144(3): 274278.

26. L Valiengo , IM Benseñor , AC Goulart , etal. The sertraline versus electrical current therapy for treating depression clinical study (select-tdcs): results of the crossover and follow-up phases. Depress Anxiety. 2013; 30(7): 646653.

27. M Hamilton . A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23: 5662.

28. SA Montgomery , M Asberg . A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134: 382389.

29. RC Young , JT Biggs , VE Ziegler , DA Meyer . A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978; 133: 429435.

30. P Bech , P Allerup , LF Gram , etal. The Hamilton depression scale. Evaluation of objectivity using logistic models. Acta Psychiatr Scand. 1981; 63: 290299.

32. DM Martin , A Alonzo , PB Mitchell , etal. Fronto-extracephalic transcranial direct current stimulation as a treatment for major depression: An open-label pilot study. J Affect Disord. 2011; 134(1–3): 459463.

33. V Gálvez , A Alonzo , D Martin , etal. Hypomania induction in a patient with bipolar II disorder by transcranial direct current stimulation (tDCS). J ECT. 2011; 27(3): 256258.

34. JP O'Reardon , HB Solvason , PG Janicak , etal. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007; 62: 12081216.

35. DA Groves , VJ Brown . Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neurosci Biobehav Rev. 2005; 29: 493500.

36. AM Lozano , P Giacobbe , C Hamani , etal. A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment-resistant depression. J Neurosurg. 2012; 116(2): 315322.

37. HA Sackeim , RF Haskett , BH Mulsant , etal. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001; 285: 12991307.

38. V Navarro . Improving medication compliance in patients with depression: use of orodispersible tablets. Adv Ther. 2010; 27: 785795.

39. D Gourion , A Galinowski , L Baraille , H Picard . [Switch antidepressants: when? how? why?] Encephale. 2011; 37(suppl 1): S50S57. In French.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

CNS Spectrums
  • ISSN: 1092-8529
  • EISSN: 2165-6509
  • URL: /core/journals/cns-spectrums
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 29 *
Loading metrics...

Abstract views

Total abstract views: 254 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th September 2017. This data will be updated every 24 hours.