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Transcranial Direct Current Stimulation (tDCS) in Mice
Published on: September 23, 2018
Transcranial Direct Current Stimulation (tDCS) for the Treatment of Hemolacria Comorbid With Psychiatric and Somatic
Roghayeh Mohammadi1, Ahmad Alipour1
1Department of Psychology Payame Noor University Tehran Iran.
Hemolacria is a rare condition characterized by bloody tears. Its etiology is often multifactorial, but functional/psychosomatic mechanisms have been proposed when organic causes are excluded. A 48-year-old woman with a history of multiple traumatic brain injuries (coma in 2008, car accident in 2017) presented with refractory generalized anxiety disorder, major depressive disorder, insomnia disorder, and treatment-resistant hypertension. Since 2022, she developed bilateral hemolacria with a baseline frequency of 4-5 episodes daily despite extensive negative ophthalmological, neurological, hematological, and imaging workups. She had been on stable doses of sertraline 100 mg/day, amlodipine 10 mg/day, losartan 100 mg/day, and intermittent zolpidem for at least 6 months. Anodal transcranial direct current stimulation (tDCS) targeting the left dorsolateral prefrontal cortex (L-DLPFC; anode F3, cathode Fp2) was administered for 27 sessions over 61 days (1-2 mA, 20 min/session, 5 days/week). No concurrent medication changes were made during or after the intervention. Marked clinical improvement began around session 12. By session 27, standardized scores showed remission of symptoms (HAM-D-17 from 26 to 4, HAM-A from 34 to 6, PSQI from 16 to 5), office blood pressure normalized to 125-135/80-85 mmHg, and hemolacria frequency decreased to one minor episode every 43 days. All improvements were sustained at the 3-month follow-up without further tDCS. This single-case, open-label report describes concurrent reductions in psychiatric, cardiovascular, and hemolacria symptoms that occurred in temporal association with anodal tDCS over the L-DLPFC in a treatment-refractory patient after organic causes had been excluded. Given the uncontrolled design, causality cannot be established; alternative explanations including placebo response, non-specific effects of clinical attention, regression to the mean, or spontaneous remission cannot be excluded. Randomized controlled trials are warranted to investigate the potential efficacy and mechanisms of tDCS in functional hemolacria.
Hemolacria is a rare condition characterized by bloody tears. Its etiology is often multifactorial, but functional/psychosomatic mechanisms have been proposed when organic causes are excluded. A 48-year-old woman with a history of multiple traumatic brain injuries (coma in 2008, car accident in 2017) presented with refractory generalized anxiety disorder, major depressive disorder, insomnia disorder, and treatment-resistant hypertension. Since 2022, she developed bilateral hemolacria with a baseline frequency of 4-5 episodes daily despite extensive negative ophthalmological, neurological, hematological, and imaging workups. She had been on stable doses of sertraline 100 mg/day, amlodipine 10 mg/day, losartan 100 mg/day, and intermittent zolpidem for at least 6 months. Anodal transcranial direct current stimulation (tDCS) targeting the left dorsolateral prefrontal cortex (L-DLPFC; anode F3, cathode Fp2) was administered for 27 sessions over 61 days (1-2 mA, 20 min/session, 5 days/week). No concurrent medication changes were made during or after the intervention. Marked clinical improvement began around session 12. By session 27, standardized scores showed remission of symptoms (HAM-D-17 from 26 to 4, HAM-A from 34 to 6, PSQI from 16 to 5), office blood pressure normalized to 125-135/80-85 mmHg, and hemolacria frequency decreased to one minor episode every 43 days. All improvements were sustained at the 3-month follow-up without further tDCS. This single-case, open-label report describes concurrent reductions in psychiatric, cardiovascular, and hemolacria symptoms that occurred in temporal association with anodal tDCS over the L-DLPFC in a treatment-refractory patient after organic causes had been excluded. Given the uncontrolled design, causality cannot be established; alternative explanations including placebo response, non-specific effects of clinical attention, regression to the mean, or spontaneous remission cannot be excluded. Randomized controlled trials are warranted to investigate the potential efficacy and mechanisms of tDCS in functional hemolacria.
