School of Psychology, University of East London, London, UK.
Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Int Rev Psychiatry. 2021 May;33(3):250-265. doi: 10.1080/09540261.2021.1879030. Epub 2021 Mar 11.
Transcranial direct current stimulation (tDCS) is a novel treatment option for major depression which could be provided as a first-line treatment. tDCS is a non-invasive form of transcranial stimulation which changes cortical tissue excitability by applying a weak (0.5-2 mA) direct current via scalp electrodes. Anodal and cathodal stimulation leads to depolarisation and hyperpolarisation, respectively, and cumulative effects are observed with repeated sessions. The montage in depression most often involves anodal stimulation to the left dorsolateral prefrontal cortex. Rates of clinical response, remission, and improvements in depressive symptoms following a course of active tDCS are greater in comparison to a course of placebo sham-controlled tDCS. In particular, the largest treatment effects are evident in first episode and recurrent major depression, while minimal effects have been observed in treatment-resistant depression. The proposed mechanism is neuroplasticity at the cellular and molecular level. Alterations in neural responses have been found at the stimulation site as well as subcortically in prefrontal-amygdala connectivity. A possible mediating effect could be cognitive control in emotion dysregulation. Additional beneficial effects on cognitive impairments have been reported, which would address an important unmet need. The tDCS device is portable and can be used at home. Clinical trials are required to establish the efficacy, feasibility and acceptability of home-based tDCS treatment and mechanisms.
经颅直流电刺激(tDCS)是一种治疗重度抑郁症的新方法,可以作为一线治疗方法。tDCS 是一种非侵入性的经颅刺激方式,通过头皮电极施加弱(0.5-2mA)直流电来改变皮质组织的兴奋性。阳极和阴极刺激分别导致去极化和超极化,并且随着重复疗程可观察到累积效应。在抑郁症中,最常见的刺激方式是对左侧背外侧前额叶进行阳极刺激。与安慰剂假刺激相比,积极 tDCS 疗程后临床反应、缓解率和抑郁症状改善的比例更高。特别是在首次发作和复发性重度抑郁症中,治疗效果最大,而在难治性抑郁症中,效果最小。其提出的机制是细胞和分子水平的神经可塑性。在刺激部位以及前额叶-杏仁核连接的皮质下区域都发现了神经反应的改变。认知控制在情绪失调中可能起到了中介作用。据报道,该疗法还具有认知障碍的有益作用,这将满足一个重要的未满足需求。tDCS 设备便携,可以在家中使用。需要进行临床试验来确定基于家庭的 tDCS 治疗和机制的疗效、可行性和可接受性。
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