Transcranial direct current stimulation: A novel approach in the treatment of vascular depression
Raffaella Zanardi1, Sara Poletti2, Dario Prestifilippo2
1IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Mood Disorder Unit, Milan, Italy; University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy.
Insights
Transcranial Direct Current Stimulation (tDCS) significantly improved depressive symptoms and cognitive function in elderly patients with vascular depression when used alongside sertraline. Twice-daily tDCS showed superior results compared to sham treatment and once-daily stimulation.
Area of Science:
- Neuroscience
- Geriatric Psychiatry
- Clinical Psychology
Background:
- Vascular depression is a challenging late-life disorder with limited treatment efficacy.
- Current treatments for depression are often ineffective, particularly for elderly patients with vascular depression.
- Transcranial Direct Current Stimulation (tDCS) shows promise for treating depression and cognitive deficits.
Purpose of the Study:
- To investigate the efficacy of tDCS as an add-on therapy to sertraline for vascular depression.
- To assess the impact of tDCS on both depressive symptoms and cognitive functions in elderly patients.
- To compare the effects of different tDCS stimulation frequencies (once vs. twice daily) against a sham condition.
Main Methods:
- A double-blind randomized study involving 93 elderly inpatients diagnosed with vascular depression.
- Weekly assessment of depressive symptoms using the Hamilton Depression Rating Scale (HDRS).
- Cognitive function evaluation using the Milan Overall Dementia Assessment (MODA) at baseline and post-treatment.
- Patients were randomized into three groups: once-daily tDCS, twice-daily tDCS, or sham tDCS for 10 working days.
Main Results:
- A significant interaction between time and treatment was observed for HDRS scores, indicating differential treatment effects.
- Twice-daily tDCS (Group II) showed significantly greater improvement in depressive symptoms compared to the sham group and once-daily tDCS group at T2.
- Cognitive function (MODA scores) improved significantly in both tDCS groups (Group I and II) compared to baseline, with no significant difference between the two tDCS groups.
Conclusions:
- tDCS, as an augmentation strategy to pharmacotherapy, is a potential treatment for vascular depression, which is often resistant to antidepressants alone.
- The non-invasive nature, minimal side effects, and affordability of tDCS make it a valuable clinical tool.
- Twice-daily tDCS may offer superior benefits for depressive symptoms in vascular depression compared to once-daily stimulation or sham treatment.
Background:
Despite the impact of depression in terms of personal suffering and socioeconomic burden, most currently available treatment options are often ineffective. A particularly difficult-to-treat depressive disorder characteristic of the elderly is vascular depression, a late-life depressive syndrome related to a variety of potential vascular mechanisms. Transcranial Direct Current Stimulation (tDCS), a non-invasive and effective somatic approach to depression, also showed positive effects on cognitive deficits.
Aim:
We performed a double-blind randomized study to investigate the efficacy of tDCS as augmentation strategy to sertraline in the treatment of vascular depression, hypothesizing a positive effect in both depressive symptoms and cognitive functions.
Methods:
We enrolled 93 inpatients over 60 years of age with a diagnosis of vascular depression. Depressive symptoms were weekly assessed (T0, T1, T2) with the 21-items Hamilton depression rating scale (HDRS). Cognitive functioning was evaluated with the Milan Overall Dementia Assessment (MODA) at baseline and after the treatment protocol. All patients were randomly assigned into three groups, Group I: one tDCS stimulation per day, Group II: two tDCS stimulations per day, Sham group: one sham tDCS stimulation per day. Stimulation was performed for 10 consecutive working days.
Results:
A significant interaction time∗treatment was observed on HDRS scores (F = 14, p < 0.001). All groups improved at T1 but whereas Group II significantly differed from the Sham group (p < 0.001) we observed no difference between Sham and Group I. At T2 all groups improved but Group II showed the greater improvement (vs. Sham p < 0.001; vs. Group I p < 0.001) and the Sham group the smallest (vs. Group I p = 0.005). A significant interaction time∗treatment was also observed on MODA scores (F = 3.31, p = 0.04). Only subjects treated with tDCS improved at T2 (Group I: p < 0.001; Group II: p = 0.007). However, no difference between Group I and II was shown.
Conclusion:
tDCS as augmentation treatment of an adequate pharmacotherapy is a potential strategy in the management of vascular depression, a disease known to be often unresponsive to antidepressants only. Non-invasiveness, the absence of severe side effects and the possibility of administering it to outpatients at an affordable price make tDCS an important tool in clinical practice.
