Efficacy and neurophysiological predictors of treatment response of adjunct bifrontal transcranial direct current stimulation (tDCS) in treating unipolar and bipolar depression

Yen-Yue Lin; Chuan-Chia Chang; Cathy Chia-Yu Huang; Nian-Sheng Tzeng; Yu-Chen Kao; Hsin-An Chang

doi:10.1016/j.jad.2020.11.030

Efficacy and neurophysiological predictors of treatment response of adjunct bifrontal transcranial direct current stimulation (tDCS) in treating unipolar and bipolar depression

J Affect Disord. 2021 Feb 1;280(Pt A):295-304. doi: 10.1016/j.jad.2020.11.030. Epub 2020 Nov 11.

Authors

Yen-Yue Lin¹, Chuan-Chia Chang², Cathy Chia-Yu Huang³, Nian-Sheng Tzeng², Yu-Chen Kao⁴, Hsin-An Chang⁵

Affiliations

¹ Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Department of Life Sciences, National Central University, Taoyuan, Taiwan.
² Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
³ Department of Life Sciences, National Central University, Taoyuan, Taiwan.
⁴ Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan.
⁵ Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: chang.ha@mail.ndmctsgh.edu.tw.

PMID: 33221715
DOI: 10.1016/j.jad.2020.11.030

Abstract

Background: Although add-on transcranial direct current stimulation (tDCS) is a promising intervention for treating unipolar (UD) and bipolar depression (BD), its moderate antidepressant efficacy urges research into biomarkers for predicting therapeutic response and achieving highly targeted applications.

Methods: This open-label trial enrolled UD (N=58) and BD (N=22) patients who had failed 1 or more trials of adequate pharmacologic interventions (ClinicalTrials.gov ID: NCT03287037). Bifrontal tDCS (anode/cathode: F3/F4) was applied using a 2 mA current for 20 min, twice daily, for 5 consecutive weekdays. Depression was measured with Hamilton Depression Rating Scale-17 (HAMD) at baseline, after 10-session stimulation, 1- and 4-week follow-ups. Heart rate (HR) and heart rate variability (HRV) was measured at baseline, during the initial 5 min of the 1^st session, after 10-session stimulation, 1- and 4-week follow-ups. Cognitive performance and other outcomes were also assessed.

Results: Bifrontal tDCS rapidly and equally improved depression in both groups. The effects persisted until the end of the trial. Both groups had similar improvements in cognitive performance, anxiety, and psychosocial functioning. Compared with baseline, increased vagally-mediated HRV was observed one month after tDCS for both groups. A positive correlation was found between HR deceleration within the 1^st session and treatment response after 10-session tDCS only among UD patients, explaining 20% of the variance.

Conclusion: tDCS as an adjunct therapy is effective for both UD and BD. Data suggest that the greater the increase in parasympathetic signaling during the 1^st session, the better the clinical response after 10-session tDCS for UD patients.

Keywords: Bipolar depression; Dorsolateral prefrontal cortex; Neurophysiological predictor; Transcranial direct current stimulation; Unipolar depression.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Bipolar Disorder* / therapy
Depressive Disorder, Major*
Double-Blind Method
Humans
Prefrontal Cortex
Transcranial Direct Current Stimulation*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT03287037