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Transcranial direct current stimulation shows potential for bipolar depression

Transcranial direct current stimulation, or tDCS, was effective, tolerable and safe as an add-on treatment in a sample of 59 patients with bipolar depression, according to study findings.

“Meta-analyses and randomized sham-controlled trials showed tDCS efficacy for unipolar depression. Moreover, tDCS has clinical advantages, such as low cost, portability, and ease of use,” Bernardo Sampaio-Junior, MD, from the department and Institute of Psychiatry at the University of São Paulo Medical School in Brazil, and colleagues wrote in JAMA Psychiatry. “However, to our knowledge, no randomized sham-controlled trial using tDCS has been conducted for [bipolar depression].”

Researchers studied the efficacy and safety of tDCS as an add-on treatment in 59 patients with type I or II bipolar disorder in a major depressive episode who were simultaneously receiving pharmacologic therapies in the randomized, double-blind Bipolar Depression Electrical Treatment Trial (BETTER). The study was conducted at University Hospital, University of São Paulo, Brazil, from July 1, 2014 to Mar. 30, 2016. After 6 weeks of therapy, they compared the differences in antidepressive effects between patients who were randomly assigned to receive either 10 daily 30-minute sessions of active or sham tDCS on weekdays and then one session every fortnight until week 6.

Of 59 patients enrolled in the study (36 with bipolar I and 23 with bipolar II depression), 52 finished the trial. Analysis revealed that patients who received active tDCS showed significant superior improvement in depression scores compared with those who received sham tDCS (number needed to treat, 5.8; 95% CI, 3.3-25.8; P = .01). Transcranial DCS was tolerable and safe, with both groups showing similar treatment-emergent affective switch rates. Response rates in the active tDCS group were superior to those in the sham group for sustained response (67.6% vs. 30.4%; number needed to treat, 2.69; 95% CI, 1.84-4.99; P = .01), but not for sustained remission (37.4% vs. 19.1%; number needed to treat, 5.46; 95% CI, 3.38-14.2; P = .18). Although adverse events were similar between groups, skin redness rates were significantly higher (P = .01) in the active group (54%) compared with the sham group (19%) at 6 weeks.

“Transcranial direct current stimulation was an effective and tolerable add-on treatment in this subsample of patients with type I or II bipolar disorder who were in a major depressive episode, with similar rates of treatment-emergent affective switches compared with sham,” Sampaio-Junior and colleagues wrote. “Although preliminary, our results are promising and encourage further trials to examine the efficacy of tDCS in a large bipolar disorder sample.” – by Savannah Demko

Disclosures: Sampaio-Junior reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.