University Hospital, University of São Paulo, São Paulo, Brazil.
Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
Depress Anxiety. 2019 Mar;36(3):262-268. doi: 10.1002/da.22878. Epub 2019 Jan 14.
The efficacy of transcranial direct current stimulation (tDCS) as a continuation therapy for the maintenance phase of the depressive episode is low and insufficiently investigated in literature. We investigated whether it could be enhanced by using a more intensive treatment regimen compared to previous reports.
Twenty-four patients (16 with unipolar depression and eight with bipolar depression) who presented acute tDCS response (≥50% depression improvement in the Hamilton Depression Rating Scale [HDRS]) after receiving 15 tDCS sessions were followed for up to 6 months or until relapse, defined as clinical worsening and/or HDRS > 15. Sessions were performed twice a week (maximum of 48 sessions) over 24 weeks. The anode and the cathode were positioned over the left and right dorsolateral prefrontal cortex (2 mA current, 30 min sessions were delivered). We performed Kaplan-Meier survival analysis and Cox proportional hazards ratios to evaluate predictors of relapse.
Out of 24 patients, 18 completed the follow-up period. tDCS treatment was well tolerated. The mean survival duration was 17.5 weeks (122 days). The survival rate at the end of follow-up was 73.5% (95% confidence interval, 50-87). A trend (P = 0.09) was observed for lower relapse rates in nontreatment- vs. antidepressant treatment-resistant patients (7.7% vs. 45.5%, respectively). No differences in efficacy between unipolar and bipolar depression were observed.
An intensive tDCS treatment regimen consisting of sessions twice a week achieved relatively low relapse rates after a 6-month follow up of tDCS responders, particularly for nontreatment-resistant patients.
经颅直流电刺激（tDCS）作为抑郁发作维持期的延续治疗的疗效较低，且文献研究不足。我们研究了与之前的报告相比，使用更密集的治疗方案是否可以增强其疗效。
24 名患者（16 名单相抑郁患者和 8 名双相抑郁患者）在接受 15 次 tDCS 治疗后出现急性 tDCS 反应（汉密尔顿抑郁评定量表[HDRS]评分≥50%改善），随后进行了长达 6 个月或直至复发的随访，复发定义为临床恶化和/或 HDRS>15。每周进行两次治疗（最多进行 48 次治疗），持续 24 周。阳极和阴极分别放置在左、右背外侧前额叶皮层（2 mA 电流，每次 30 分钟）。我们进行了 Kaplan-Meier 生存分析和 Cox 比例风险比来评估复发的预测因素。
在 24 名患者中，有 18 名完成了随访期。tDCS 治疗耐受性良好。平均生存时间为 17.5 周（122 天）。随访结束时的生存率为 73.5%（95%置信区间，50-87）。未接受治疗的患者与抗抑郁药物治疗抵抗的患者相比，复发率较低（分别为 7.7%和 45.5%，趋势 P=0.09）。未观察到单相和双相抑郁患者之间疗效的差异。
每周两次治疗的密集 tDCS 治疗方案在对 tDCS 反应者进行 6 个月的随访后，复发率相对较低，特别是对于未接受治疗的患者。
