Transcranial Direct Current Stimulation (tDCS) was found to be an adequate pharmacotherapy for managing symptoms of vascular depression during a double-blind randomized study, the findings of which were published in Brain Stimulation.
Researchers from the San Raffaele Scientific Institute in Italy recruited inpatients (N=93) over 60 years of age presenting with cerebral vascular disease who had been diagnosed with Major Depressive Disorder (n=77) or Bipolar Disorder (n=16). All patients were treated with sertraline for 2 weeks followed by a stabilized dose (100-200 mg/day) and randomized to receive 1 sham (n=31), 1 tDCS (n=31), or 2 tDCS (n=31) treatments Monday through Friday for 2 weeks. Patients were assessed by the Hamilton Depression Rating Scale (HDRS) and the Milan Overall Dementia Assessment (MODA).
At baseline the patients groups (sham, 1 tDCS, and 2 tDCS) differed significantly for illness duration (24.84 vs 18.87 vs 30.38 years; P =.010), MODA score (84.62 vs 82.08 vs 87.97; P =.009), and redness (10% vs 48% vs 55%; P <.001), respectively.
During the study, the investigators observed a significant interaction between time and treatment on HDRS (F=14.02; P <.001) and MODA (F=3.31; P =.04) scores.
After 1 week of treatment, all 3 cohorts exhibited improved HDRS scores (sham: P =.004; 1 tDCS: P <.001; 2 tDCS: P <.001) which continued through week 2 (sham: P =.02; 1 tDCS: P <.001; 2 tDCS: P <.001). Patients in the 2 tDCS treatment group exhibited the greatest improvement compared with the sham (P <.001) or single tDCS treatment (P <.001) groups.
At the study conclusion, improved MODA scores were observed in both treatment groups (1 tDCS: P <.001; 2tDCS: P =.007). The change in MODA score was independent from clinical improvement, remaining significant after correcting for symptoms of depression (F=4.11; P =.019).
Response to treatment was not observed among patients in the sham group. At the study conclusion 42% of the single and 68% of the double treatment groups achieved a response to treatment. Remission was reported by 29% of the single tDCS and 58% of the double tDCS group (c=25.36; P <.001). No remission was observed among participants in the sham cohort.
The duration of current depressive episode and HDRS score at baseline were indicative of patient response; in which patients with a longer depressive episode were less likely to respond to treatment (parameter estimate=0.06; Wald W=8.82; P =.003) and those with higher baseline HDRS scores were less likely to achieve remission (parameter estimate=0.05; Wald W=6.07; P =.013).
A limitation of this study was the choice to treat all patients with sertraline for 2 weeks prior to tDCS treatment. The investigators were unable to rule out the possibility that the overserved effect may have been in part a response to sertraline.
The study authors concluded that tDCS was a safe and effective tool for the use of treating depression among adults with cerebrovascular disease. In addition to the reduction of depressive symptoms, patients exhibited improved cognition.
Zanardi R, Poletti S, Prestifilippo D, Attanasio F, Barbini B, Colombo C. Transcranial direct current stimulation: a novel approach in the treatment of vascular depression. Brain Stimul. 2020;13(6):1559-1565. doi: 10.1016/j.brs.2020.08.013