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Transcranial direct current stimulation in the treatment of major depression: a meta-analysis

  • U. G. Kalu (a1), C. E. Sexton (a1), C. K. Loo (a1) and K. P. Ebmeier (a1)
Abstract
Background

So far, no comprehensive answer has emerged to the question of whether transcranial direct current stimulation (tDCS) can make a clinically useful contribution to the treatment of major depression. We aim to present a systematic review and meta-analysis of tDCS in the treatment of depression.

Method

Medline and Embase were searched for open-label and randomized controlled trials of tDCS in depression using the expressions (‘transcranial direct current stimulation’ or ‘tDCS’) and (‘depression’ or ‘depressed’). Study data were extracted with a standardized data sheet. For randomized controlled trials, effect size (Hedges' g) was calculated and the relationships between study variables and effect size explored using meta-regression.

Results

A total of 108 citations were screened and 10 studies included in the systematic review. Six randomized controlled trials were included in the meta-analysis, with a cumulative sample of 96 active and 80 sham tDCS courses. Active tDCS was found to be more effective than sham tDCS for the reduction of depression severity (Hedges' g=0.743, 95% confidence interval 0.21–1.27), although study results differed more than expected by chance (Q=15.52, df=6, p=0.017, I 2=61.35). Meta-regression did not reveal any significant correlations.

Conclusions

Our study was limited by the small number of studies included, which often had small sample size. Future studies should use larger, if possible representative, health service patient samples, and optimized protocols to evaluate the efficacy of tDCS in the treatment of depression further.

Copyright
Corresponding author
*Address for correspondence: K. P. Ebmeier, M.D., Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. (Email: klaus.ebmeier@psych.ox.ac.uk)
References
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Alonzo A, Brassil J, Taylor JL, Martin D, Loo CK (2011). Daily transcranial direct current stimulation (tDCS) leads to greater increases in cortical excitability than second daily transcranial direct current stimulation. Brain Stimulation. Published online 25 May 2011. doi:10.1016/j.brs.2011.04.006.
Arfai E, Theano G, Montagu JD, Robin AA (1970). A controlled study of polarization in depression. British Journal of Psychiatry 116, 433434.
Arul-Anandam AP, Loo C, Mitchell P (2010). Induction of hypomanic episode with transcranial direct current stimulation. Journal of ECT 26, 6869.
Baccaro A, Brunoni AR, Bensenor IM, Fregni F (2010). Hypomanic episode in unipolar depression during transcranial direct current stimulation. Acta Neuropsychiatrica 22, 316318.
Baker AP (1970). Brain stem polarization in the treatment of depression. South African Medical Journal 44, 473475.
Begg CB, Mazumdar M (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics 50, 10881101.
Bindman LJ, Lippold OCJ, Redfearn JW (1964). The action of brief polarizing currents on cerebral cortex of the rat (1) during current flow and (2) in production of long-lasting after-effects. Journal of Physiology 172, 369382.
Boggio PS, Rigonatti SP, Ribeiro RB, Myczkowski ML, Nitsche MA, Pascual-Leone A, Fregni F (2008). A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. International Journal of Neuropsychopharmacology 11, 249254.
Brunoni AR, Amadera J, Berbel B, Volz MS, Rizzerio BG, Fregni F (2011 a). A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. International Journal of Neuropsychopharmacology 14, 11331145.
Brunoni AR, Ferrucci R, Bortolomasi M, Vergari M, Tadini L, Boggio PS, Giacopuzzi M, Barbieri S, Priori A (2011 b). Transcranial direct current stimulation (tDCS) in unipolar vs. bipolar depressive disorder. Progress in Neuropsychopharmacology and Biological Psychiatry 35, 96101.
Brunoni AR, Valiengo L, Baccaro A, Zanao TA, de Oliveira JF, Vieira GP, Bueno VF, Goulart AC, Boggio PS, Lotufo PA, Bensenor IM, Fregni F (2011 c). Sertraline vs. ELectrical Current Therapy for Treating Depression Clinical Trial – SELECT TDCS: design, rationale and objectives. Contemporary Clinical Trials 32, 9098.
Carney MW, Cashman MD, Sheffield BF (1970). Polarization in depression. British Journal of Psychiatry 117, 474475.
Costain R, Redfearn JW, Lippold OCJ (1964). Controlled trial of therapeutic effects of polarization of brain depressive-illness. British Journal of Psychiatry 110, 786799.
Dell'Osso B, Zanoni S, Ferrucci R, Vergari M, Castellano F, D'Urso N, Dobrea C, Benatti B, Arici C, Priori A, Altamura AC (2011). Transcranial direct current stimulation for the outpatient treatment of poor-responder depressed patients. European Psychiatry. Published online 27 May 2011. doi:10.1016/j.eurpsy.2011.02.008.
Egger M, Davey Smith G, Schneider M, Minder C (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629634.
Ferrucci R, Bortolomasi M, Brunoni A, Vergari M, Tadini L, Giacopuzzi M, Priori A (2009). Comparative benefits of transcranial direct current stimulation (TDCS). Treatment in patients with mild/moderate vs. severe depression. Clinical Neuropsychiatry 6, 246251.
Fregni F, Boggio PS, Nitsche MA, Marcolin MA, Rigonatti SP, Pascual-Leone A (2006 a). Treatment of major depression with transcranial direct current stimulation. Bipolar Disorders 8, 203204.
Fregni F, Boggio PS, Nitsche MA, Rigonatti SP, Pascual-Leone A (2006 b). Cognitive effects of repeated sessions of transcranial direct current stimulation in patients with depression. Depression and Anxiety 23, 482484.
Galvez V, Alonzo A, Martin D, Mitchell PB, Sachdev P, Loo CK (2011). Hypomania induction in a patient with bipolar II disorder by transcranial direct current stimulation (tDCS). Journal of ECT 27, 256258.
Grimm S, Beck J, Schuepbach D, Hell D, Boesiger P, Bermpohl F, Niehaus L, Boeker H, Northoff G (2008). 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. Biological Psychiatry 63, 369376.
Hedges D, Vevea J (1998). Fixed- and random-effects models in meta-analysis. Psychological Methods 3, 486504.
Heo M, Murphy CF, Meyers BS (2007). Relationship between the Hamilton Depression Rating Scale and the Montgomery–Asberg Depression Rating Scale in depressed elderly: a meta-analysis. American Journal of Geriatric Psychiatry 15, 899905.
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557560.
Koenigs M, Ukueberuwa D, Campion P, Grafman J, Wassermann E (2009). Bilateral frontal transcranial direct current stimulation: failure to replicate classic findings in healthy subjects. Clinical Neurophysiology 120, 8084.
Kuo MF, Grosch J, Fregni F, Paulus W, Nitsche MA (2007). Focusing effect of acetylcholine on neuroplasticity in the human motor cortex. Journal of Neuroscience 27, 1444214447.
Kuo MF, Paulus W, Nitsche MA (2008). Boosting focally-induced brain plasticity by dopamine. Cerebral Cortex 18, 648651.
Lippold OCJ, Redfearn JW (1964). Mental changes resulting from passage of small direct currents through human brain. British Journal of Psychiatry 110, 768772.
Loo C, Martin D, Alonzo A, Gandevia S, Mitchell P, Sachdev P (2011). Avoiding skin burns with transcranial direct current stimulation: preliminary considerations. International Journal of Neuropsychopharmacology 14, 425426.
Loo CK, Alonzo A, Martin D, Mitchell P, Galvez V, Sachdev P (2012). A three-week, randomized, sham-controlled trial of transcranial direct current stimulation in depression. British Journal of Psychiatry 200, 18. doi:10.1192/bjp.bp.111.097634.
Loo CK, Sachdev P, Martin D, Pigot M, Alonzo A, Malhi GS, Lagopoulos J, Mitchell P (2010). A double-blind, sham-controlled trial of transcranial direct current stimulation for the treatment of depression. International Journal of Neuropsychopharmacology 13, 6169.
Martin DM, Alonzo A, Mitchell PB, Sachdev P, Galvez V, Loo CK (2011). Fronto-extracephalic transcranial direct current stimulation as a treatment for major depression: an open-label pilot study. Journal of Affective Disorders 134, 459463.
Nias DK, Shapiro MB (1974). The effects of small electrical currents upon depressive symptoms. British Journal of Psychiatry 125, 414415.
Nitsche MA, Boggio PS, Fregni F, Pascual-Leone A (2009). Treatment of depression with transcranial direct current stimulation (tDCS): a review. Experimental Neurology 219, 1419.
Nitsche MA, Fricke K, Henschke U, Schlitterlau A, Liebetanz D, Lang N, Henning S, Tergau F, Paulus W (2003). Pharmacological modulation of cortical excitability shifts induced by transcranial direct current stimulation in humans. Journal of Physiology 553, 293301.
Nitsche MA, Niehaus L, Hoffmann KT, Hengst S, Liebetanz D, Paulus W, Meyer BU (2004). MRI study of human brain exposed to weak direct current stimulation of the frontal cortex. Clinical Neurophysiology 115, 24192423.
Nitsche MA, Paulus W (2000). Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. Journal of Physiology 527, 633639.
Nitsche MA, Paulus W (2001). Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology 57, 18991901.
Palm U, Keeser D, Schiller C, Fintescu Z, Nitsche M, Reisinger E, Padberg F (2008). Skin lesions after treatment with transcranial direct current stimulation (tDCS). Brain Stimulation 1, 386387.
Palm U, Schiller C, Fintescu Z, Obermeier M, Keeser D, Reisinger E, Pogarell O, Nitsche MA, Möller HJ, Padberg F (2011). Transcranial direct current stimulation in treatment resistant depression: a randomized double-blind, placebo-controlled study. Brain Stimulation. Published online 7 September 2011. doi:10.1016/j.brs.2011.08.005.
Priori A (2003). Brain polarization in humans: a reappraisal of an old tool for prolonged non-invasive modulation of brain excitability. Clinical Neurophysiology 114, 589595.
Priori A, Berardelli A, Rona S, Accornero N, Manfredi M (1998). Polarization of the human motor cortex through the scalp. Neuroreport 9, 22572260.
Ramsay JC, Schlagenhauf G (1966). Treatment of depression with low voltage direct current. Southern Medical Journal 59, 932934.
Redfearn JW, Costain R, Lippold OCJ (1964). Preliminary account of clinical effects of polarizing brain in certain psychiatric disorders. British Journal of Psychiatry 110, 773785.
Slotema CW, Blom JD, Hoek HW, Sommer IE (2010). Should we expand the toolbox of psychiatric treatment methods to include repetitive transcranial magnetic stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders. Journal of Clinical Psychiatry 71, 873884.
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