Transcranial Direct Current Stimulation Inferior to Escitalopram

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More adverse events occurred among patients receiving transcranial direct current stimulation treatments than patients receiving escitalopram or in the placebo group.
More adverse events occurred among patients receiving transcranial direct current stimulation treatments than patients receiving escitalopram or in the placebo group.

Transcranial direct current stimulation (tDCS) treats depression more effectively than placebo but did not outperform escitalopram, according to recent research published in the New England Journal of Medicine. Further, more adverse events occurred among patients receiving tDCS treatments than among patients receiving escitalopram or in the placebo group.

"In secondary-outcome superiority analyses, escitalopram was superior to tDCS and placebo, and tDCS was superior to placebo," wrote André R. Brunoni, from the University of São Paulo in Brazil, and colleagues.

"Patients in the trial had moderate-to-severe depressive symptoms, and there was a high prevalence of coexisting anxiety disorder, a combination that reflects a typical clinical population in which treatment for depression is indicated."

The researchers randomly assigned 245 adults with depression to receive 1 of 3 interventions: 94 received tDCS and an oral placebo, 91 received sham tDCS and escitalopram, and 60 received sham tDCS and an oral placebo (complete placebo group). Those receiving tDCS had 30-minute sessions every day for 15 consecutive weekdays, and then 7 weekly treatments. Patients receiving escitalopram first took 10 mg a day for 3 weeks, followed by 20 mg daily.

A total of 292 patients received all 22 treatments with real or sham tDCS, including 72 in the tDCS group, 75 in the escitalopram group, and 55 in the placebo group.

The researchers assessed participants' symptoms at baseline and 10 weeks after starting therapy, using the Hamilton Depression Rating Scale, measured from 0 to 52, with higher scores equating to greater depression. Participants receiving escitalopram had a mean decrease of 11.3 points on the scale after 10 weeks of therapy. The tDCS group saw a mean 9-point decrease from baseline, and the placebo group had a mean 5.8-point decrease.

"Neuropsychological assessments showed either an improvement in cognitive performance or no changes in performance from baseline to 10 weeks in each of the three trial groups," the authors reported.

A comparison of the lower boundaries of confidence intervals for reduction in the participants' depression scores revealed that tDCS was not inferior to escitalopram. Response and remission rates, however, were not significantly different between the tDCS and escitalopram groups.

Although total adverse events were similar across all 3 groups, a higher proportion of patients receiving escitalopram experienced sleepiness and severe constipation than other patients, and tDCS participants experienced more skin redness and tingling, itching, tinnitus, and nervousness than the others. In addition, 2 patients in the tDCS group developed new-onset mania. None of the groups had suicides, psychiatric hospitalizations, or other serious adverse events.

The authors noted that these findings may not be generalizable to treatments with a different antidepressant or different tDCS protocols.

Reference

Brunoni AR, Moffa AH, Sampaio-Junior B, et al. Trial of electrical direct-current therapy versus escitalopram for depression. N Engl J Med. 2017;376:2523-2533.

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