Departamento de Clínica Médica, Faculdade de Medicina da USP & Hospital Universitário da USP, São Paulo, Brazil; Departamento e Instituto de Psiquiatria, Faculdade de Medicina da USP & Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Universidade de São Paulo, São Paulo, Brazil.
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Leopoldstraße 13, 80802, Munich, Germany; Hochschule Fresenius, University of Applied Sciences, Infanteriestraße 11A, 80797, Munich, Germany.
J Affect Disord. 2020 Feb 15;263:344-352. doi: 10.1016/j.jad.2019.12.009. Epub 2019 Dec 5.
Cognitive deficits in major depressive disorder (MDD) are associated with low quality of life and higher suicide risk. Antidepressant drugs have modest to null effects in improving such deficits. Therefore, we investigated the cognitive effects of transcranial direct current stimulation (tDCS), which is a promising antidepressant non-pharmacological intervention, in MDD.
An exploratory analysis on cognitive performance was conducted in 243 depressed patients from the Escitalopram vs. Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS), a sham-controlled study comparing the efficacy of tDCS vs. escitalopram. A neuropsychological battery was applied at baseline and endpoint (10 weeks of treatment) to create composite cognitive scores (processing speed, working memory, and verbal fluency). Linear mixed regression models were used to evaluate changes according to intervention groups, adjusted for confounding variables (age, years of schooling, gender, and benzodiazepine use) and depression improvement.
No cognitive deterioration was observed in any group. Patients receiving tDCS presented reduced practice gains compared to placebo in processing speed. In patients receiving escitalopram vs. placebo and in the subgroup of clinical responders (>50% depression improvement from baseline), those receiving tDCS vs. placebo presented increased performance in verbal fluency. No significant differences between tDCS and escitalopram groups were detected.
Absence of healthy controls.
Prefrontal tDCS did not lead to cognitive deficits in depressed patients, although it reduced practice effects in processing speed. tDCS responders presented increased performance in verbal fluency. Further investigation of tDCS cognitive effects in depression is warranted.
重度抑郁症（MDD）患者存在认知缺陷，这与生活质量降低和自杀风险升高有关。抗抑郁药物对改善这些缺陷的效果甚微或没有效果。因此，我们研究了经颅直流电刺激（tDCS）对 MDD 的认知影响，这是一种很有前途的非药物抗抑郁干预方法。
对 Escitalopram vs. Electric Current Therapy for Treating Depression Clinical Study（ELECT-TDCS）中的 243 例抑郁患者进行了认知表现的探索性分析，该研究为一项 sham 对照研究，比较了 tDCS 与艾司西酞普兰的疗效。在基线和终点（治疗 10 周）时使用神经心理测试套件来创建综合认知评分（处理速度、工作记忆和言语流畅性）。使用线性混合回归模型根据干预组评估变化，调整混杂变量（年龄、受教育年限、性别和苯二氮䓬类药物使用）和抑郁改善情况。
任何一组均未观察到认知恶化。与安慰剂相比，接受 tDCS 的患者在处理速度方面的练习效果降低。与安慰剂相比，接受艾司西酞普兰治疗的患者和临床应答者亚组（与基线相比抑郁改善≥50%）的患者中，接受 tDCS 治疗的患者在言语流畅性方面的表现提高。未发现 tDCS 组与艾司西酞普兰组之间存在显著差异。
无健康对照组。
尽管经颅直流电刺激（tDCS）降低了处理速度方面的练习效果，但并未导致抑郁患者出现认知缺陷。tDCS 应答者的言语流畅性表现提高。需要进一步研究 tDCS 在抑郁症中的认知影响。
