Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
The Zhejiang Key Laboratory of Precision Psychiatry, Hangzhou, China.
CNS Neurosci Ther. 2024 Oct;30(10):e70077. doi: 10.1111/cns.70077.
Bipolar depression poses an overwhelming suicide risk. We aimed to examine the efficacy and safety of transcranial direct current stimulation (tDCS) combined with quetiapine in bipolar patients as a suicidal intervention.
In a single-center, double-blind, treatment-naive bipolar depression patients with suicidal ideation were randomly assigned to quetiapine in combination with either active (n = 16) or sham (n = 15) tDCS over the left dorsolateral prefrontal cortex for three consecutive weeks. The 30-min, 2-mA tDCS was conducted twice a day on the weekday of the first week and then once a day on the weekdays of the two following weeks. Primary efficacy outcome measure was the change in the Beck Scale for Suicidal Ideation (BSSI). Secondary outcomes included changes on the 17-item Hamilton Depression Rating Scale (HDRS-17) and Montgomery-Asberg Depression Rating Scale (MADRS). Outcome was evaluated on Day 3 and weekend. Safety outcome was based on the reported adverse reactions.
Active tDCS was superior to sham tDCS on the BSSI at Day 3 and tended to sustain every weekend during the treatment process, compared to baseline. However, no difference between active and sham in HDRS-17 and MADRS was found. Response and remission rate also supported the antisuicide effect of tDCS, with higher response and remission rate in BSSI, but no antidepressant effect, compared to sham, over time. Regarding safety, active tDCS was well tolerated and all the adverse reactions reported were mild and limited to transient scalp discomfort.
The tDCS was effective as an antisuicide treatment for acute bipolar depression patients with suicidal ideation, with minimal side effects reported.
双相抑郁患者自杀风险极高。本研究旨在探讨经颅直流电刺激（tDCS）联合喹硫平治疗有自杀意念的双相障碍患者的疗效和安全性。
在这项单中心、双盲、治疗初发的有自杀意念的双相障碍抑郁患者的研究中，患者被随机分为喹硫平联合真刺激（n=16）或假刺激（n=15）组，真刺激组采用左外侧前额叶皮质 tDCS 治疗，共 3 周。第 1 周的 5 个工作日内每天进行 2 次、每次 30 分钟、2 mA 的 tDCS，之后的 2 周每个工作日进行 1 次。主要疗效终点是贝克自杀意念量表（BSSI）的变化。次要终点包括 17 项汉密尔顿抑郁量表（HDRS-17）和蒙哥马利-阿斯伯格抑郁量表（MADRS）的变化。于第 3 天和周末进行评估。安全性终点基于不良反应报告。
与基线相比，在第 3 天和整个治疗过程中的每个周末，真刺激均优于假刺激，BSSI 评分降低。但在 HDRS-17 和 MADRS 方面，真刺激和假刺激之间没有差异。反应率和缓解率也支持 tDCS 的抗自杀作用，BSSI 的反应率和缓解率较高，但与假刺激相比，tDCS 没有抗抑郁作用。关于安全性，真刺激组耐受性良好，所有报告的不良反应均为轻度且局限于短暂的头皮不适。
tDCS 是一种有效的急性双相抑郁患者自杀意念的治疗方法，副作用小。
