Efficacy and acceptability of transcranial direct current stimulation (tDCS) for major depressive disorder: An individual patient data meta-analysis

Adriano H Moffa; Donel Martin; Angelo Alonzo; Djamila Bennabi; Daniel M Blumberger; Isabela M Benseñor; Zafiris Daskalakis; Felipe Fregni; Emmanuel Haffen; Sarah H Lisanby; Frank Padberg; Ulrich Palm; Lais B Razza; Bernardo Sampaio-Jr; Colleen Loo; Andre R Brunoni

doi:10.1016/j.pnpbp.2019.109836

Efficacy and acceptability of transcranial direct current stimulation (tDCS) for major depressive disorder: An individual patient data meta-analysis

Prog Neuropsychopharmacol Biol Psychiatry. 2020 Apr 20:99:109836. doi: 10.1016/j.pnpbp.2019.109836. Epub 2019 Dec 16.

Authors

Adriano H Moffa¹, Donel Martin², Angelo Alonzo², Djamila Bennabi³, Daniel M Blumberger⁴, Isabela M Benseñor⁵, Zafiris Daskalakis⁴, Felipe Fregni⁶, Emmanuel Haffen³, Sarah H Lisanby⁷, Frank Padberg⁸, Ulrich Palm⁸, Lais B Razza⁹, Bernardo Sampaio-Jr⁹, Colleen Loo², Andre R Brunoni¹⁰

Affiliations

¹ School of Psychiatry, Black Dog Institute, University of New South Wales, Hospital Rd, Randwick, Sydney, NSW 2031, Australia; Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, R Dr Ovidio Pires de Campos 785, 2o andar, 05403-000 São Paulo, Brazil.
² School of Psychiatry, Black Dog Institute, University of New South Wales, Hospital Rd, Randwick, Sydney, NSW 2031, Australia.
³ Department of Clinical Psychiatry, Clinical Investigation Center 1431 Inserm, EA 481 Neurosciences, University Hospital of Besancon and FondaMental Foundation, Créteil, France.
⁴ Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Ontario, Canada.
⁵ Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, 05508-000 São Paulo, Brazil.
⁶ Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
⁷ Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
⁸ Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany.
⁹ Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, R Dr Ovidio Pires de Campos 785, 2o andar, 05403-000 São Paulo, Brazil.
¹⁰ Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, R Dr Ovidio Pires de Campos 785, 2o andar, 05403-000 São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, 05508-000 São Paulo, Brazil. Electronic address: brunowsky@gmail.com.

PMID: 31837388
DOI: 10.1016/j.pnpbp.2019.109836

Abstract

We evaluated the efficacy and acceptability of transcranial direct current stimulation (tDCS) for treating acute depressive episodes using individual patient data that provide more precise estimates than aggregate data meta-analysis. A systematic review of placebo-controlled trials on tDCS as only intervention was conducted until December-2018. Data from each study was collated to estimate odds ratio (OR) and number needed to treat (NNT) of response and remission, and depression improvement. Endpoints were pre-determined. Nine eligible studies (572 participants), presenting moderate/high certainty of evidence, were included. Active tDCS was significantly superior to sham for response (30.9% vs. 18.9% respectively; OR = 1.96, 95%CI [1.30-2.95], NNT = 9), remission (19.9% vs. 11.7%, OR = 1.94 [1.19-3.16], NNT = 13) and depression improvement (effect size of β = 0.31, [0.15-0.47]). Moreover, continuous clinical improvement was observed even after the end of acute tDCS treatment. There were no differences in all-cause discontinuation rates and no predictors of response were identified. To conclude, active tDCS was statistically superior to sham in all outcomes, although its clinical effects were moderate.

Keywords: Bipolar disorder; Individual patient data; Major depressive disorder; Meta-analysis; Non-invasive brain stimulation; Randomized clinical trial; Systematic review; Transcranial direct current stimulation.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Depressive Disorder, Major / diagnosis
Depressive Disorder, Major / psychology*
Depressive Disorder, Major / therapy*
Humans
Patient Acceptance of Health Care / psychology*
Randomized Controlled Trials as Topic / methods
Transcranial Direct Current Stimulation / methods*
Transcranial Direct Current Stimulation / psychology*
Treatment Outcome