Treatment-emergent mania/hypomania during antidepressant treatment with transcranial direct current stimulation (tDCS): A systematic review and meta-analysis

André R Brunoni; Adriano H Moffa; Bernardo Sampaio-Júnior; Verònica Gálvez; Colleen K Loo

doi:10.1016/j.brs.2016.11.005

Treatment-emergent mania/hypomania during antidepressant treatment with transcranial direct current stimulation (tDCS): A systematic review and meta-analysis

Brain Stimul. 2017 Mar-Apr;10(2):260-262. doi: 10.1016/j.brs.2016.11.005. Epub 2016 Nov 14.

Authors

André R Brunoni¹, Adriano H Moffa², Bernardo Sampaio-Júnior³, Verònica Gálvez⁴, Colleen K Loo⁵

Affiliations

¹ Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil. Electronic address: brunoni@usp.br.
² Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil.
³ Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil.
⁴ School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia.
⁵ School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia; St George Hospital, Sydney, Australia.

PMID: 27916405
DOI: 10.1016/j.brs.2016.11.005

Abstract

Background: Treatment-emergent mania/hypomania (TEM) is a possible adverse effect of pharmacological and non-pharmacological antidepressant treatments.

Objective: We performed a systematic review and meta-analysis to evaluate the risk of TEM in depressed patients during randomized, sham-controlled trials (RCTs).

Data sources: Medline database, from the first date available to August 12, 2016.

Results: From 283 references, 10 RCTs were identified. Only 3 of them described TEM. In active and sham groups, respectively, only 8 of 226 (3.5%) and 1 of 190 (0.5%) participants presented TEM. This difference was not statistically significant (OR = 1.79, 95% CI = 0.6 to 5.32). There were also five additional reports of TEM in participants not on RCTs. No risk factors for TEM were identified.

Limitations: Low number of studies and TEM reports.

Conclusion: Despite previous reports, active vs. sham tDCS was not associated with a significantly greater number of TEM episodes.

Keywords: Bipolar disorder; Major depressive disorder; Manic switch; Transcranial direct current stimulation; Treatment-emergent mania.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Antidepressive Agents / adverse effects*
Antidepressive Agents / therapeutic use
Bipolar Disorder / chemically induced*
Bipolar Disorder / epidemiology
Bipolar Disorder / etiology*
Depressive Disorder / drug therapy
Depressive Disorder / epidemiology
Depressive Disorder / therapy
Humans
Randomized Controlled Trials as Topic / methods
Transcranial Direct Current Stimulation / adverse effects*

Substances

Antidepressive Agents