University of Southern California, Los Angeles, CA, USA.
University of California, Los Angeles, CA, USA.
Transl Psychiatry. 2021 Feb 24;11(1):138. doi: 10.1038/s41398-021-01264-3.
Recent clinical trials of transcranial direct current stimulation (tDCS) in depression have shown contrasting results. Consequently, we used in-vivo neuroimaging to confirm targeting and modulation of depression-relevant neural circuitry by tDCS. Depressed participants (N = 66, Baseline Hamilton Depression Rating Scale (HDRS) 17-item scores ≥14 and <24) were randomized into Active/Sham and High-definition (HD)/Conventional (Conv) tDCS groups using a double-blind, parallel design, and received tDCS individually targeted at the left dorsolateral prefrontal cortex (DLPFC). In accordance with Ampere's Law, tDCS currents were hypothesized to induce magnetic fields at the stimulation-target, measured in real-time using dual-echo echo-planar-imaging (DE-EPI) MRI. Additionally, the tDCS treatment trial (consisting of 12 daily 20-min sessions) was hypothesized to induce cerebral blood flow (CBF) changes post-treatment at the DLPFC target and in the reciprocally connected anterior cingulate cortex (ACC), measured using pseudo-continuous arterial spin labeling (pCASL) MRI. Significant tDCS current-induced magnetic fields were observed at the left DLPFC target for both active stimulation montages (Brodmann's area (BA) 46: p = 0.048, Cohen's d = 0.73; p = 0.018, d = 0.86; BA 9: p = 0.011, d = 0.92; p = 0.022, d = 0.83). Significant longitudinal CBF increases were observed (a) at the left DLPFC stimulation-target for both active montages (p = 3.5E-3, d = 0.98; p = 2.8E-3, d = 1.08), and (b) at ACC for the HD-montage only (p = 2.4E-3, d = 1.06; p = 0.075, d = 0.64). These results confirm that tDCS-treatment (a) engages the stimulation-target, and (b) modulates depression-relevant neural circuitry in depressed participants, with stronger network-modulations induced by the HD-montage. Although not primary outcomes, active HD-tDCS showed significant improvements of anhedonia relative to sham, though HDRS scores did not differ significantly between montages post-treatment.
最近的经颅直流电刺激（tDCS）治疗抑郁症的临床试验结果相互矛盾。因此，我们使用体内神经影像学来确认 tDCS 对与抑郁相关的神经回路的靶向和调节。将 66 名抑郁参与者（基线汉密尔顿抑郁量表（HDRS）17 项评分≥14 且<24）随机分为活性/假刺激和高分辨率（HD）/常规（Conv）tDCS 组，采用双盲、平行设计，并单独接受靶向左侧背外侧前额叶皮层（DLPFC）的 tDCS 治疗。根据安培定律，tDCS 电流假设会在刺激目标处产生磁场，使用双回波平面成像（DE-EPI）MRI 实时测量。此外，假设 tDCS 治疗试验（由 12 个每日 20 分钟的疗程组成）会在治疗后在 DLPFC 靶点和相互连接的前扣带回皮层（ACC）中引起脑血流（CBF）变化，使用伪连续动脉自旋标记（pCASL）MRI 进行测量。在左 DLPFC 靶点处观察到活性刺激模式下显著的 tDCS 电流诱导磁场（Brodmann 区（BA）46：p=0.048，Cohen's d=0.73；p=0.018，d=0.86；BA 9：p=0.011，d=0.92；p=0.022，d=0.83）。观察到左 DLPFC 刺激靶点处的 CBF 纵向显著增加，两种活性模式均为（a）（p=3.5E-3，d=0.98；p=2.8E-3，d=1.08），以及（b）仅在 HD 模式下的 ACC（p=2.4E-3，d=1.06；p=0.075，d=0.64）。这些结果证实，tDCS 治疗（a）涉及刺激靶点，（b）调节抑郁患者与抑郁相关的神经回路，HD 模式引起的网络调节更强。尽管不是主要结果，但与假刺激相比，活性 HD-tDCS 显示出显著改善快感缺失，但治疗后两种模式的 HDRS 评分无显著差异。
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