Couture Maxime, Desbeaumes Jodoin Véronique, Bousseau Emma, Sarshoghi Arash, Nitsche Michael A, Blumberger Daniel M, Bolduc Chantal, Weissman Cory R, Appelbaum Lawrence G, Daskalakis Zafiris J, Poorganji Mohsen, Lespérance Paul, Miron Jean-Philippe
Centre Hospitalier de l'Université de Montréal (CHUM) and Centre de Recherche du CHUM (CRCHUM), University of Montreal, Montreal (Couture, Desbeaumes Jodoin, Bousseau, Sarshoghi, Miron, Lespérance); IfADo Leibniz Research Center for Working Environment and Human Factors at TU Dortmund, Germany, and Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy, and German Center for Mental Health (Nitsche); Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto (Blumberger); Department of Medicine (Bolduc) and Department of Psychiatry and Addictology (Lespérance, Miron), Faculty of Medicine, University of Montreal, Montreal; Interventional Psychiatry Program, Department of Psychiatry, UC San Diego School of Medicine, San Diego (Weissman, Appelbaum, Daskalakis, Poorganji, Miron).
Am J Psychiatry. 2025 Mar 1;182(3):276-284. doi: 10.1176/appi.ajp.20240083. Epub 2025 Jan 29.
This study investigated spaced transcranial direct current stimulation for major depressive disorder, focusing on feasibility.
In a prospective open-label study, 30 participants with major depressive disorder were enrolled to receive a 50-session transcranial direct current stimulation (tDCS) treatment over 2 weeks. The feasibility, safety, tolerability, and preliminary therapeutic effects of this tDCS protocol were assessed using the 17-item Hamilton Depression Rating Scale (HAM-D-17) and the Montgomery-Åsberg Depression Rating Scale (MADRS) at baseline and 1-week and 4-week follow-ups, as well as with the 6-item HAM-D (HAM-D-6) daily during treatment.
The protocol demonstrated good feasibility, with a retention rate of 93.3% and an adherence rate of 99.7%. There were no serious adverse events. The most common side effect was a mild tingling and itching sensation during stimulation (100%) and temporary skin redness following stimulation (100%). Additionally, 64.3% of participants presented with mild irritative contact dermatitis, which had disappeared by the 1-week follow-up for most participants and completely resolved by the 4-week follow-up for the remaining cases; this was not treatment limiting and did not require specific treatment. HAM-D-17 scores decreased from a mean of 21.3 (SD=3.0) at baseline to 15.3 (SD=6.3) at 1 week and 13.2 (SD=7.1) at 4 weeks. Depressive symptom severity, as measured by the HAM-D-17, showed significant reductions over time, with similar trends observed on the MADRS. HAM-D-6 scores highlighted important differences between response groups, particularly during the later stages of treatment, suggesting a potential for differential response patterns between the 1-week and 4-week follow-ups.
The protocol was feasible, safe, and well-tolerated and led to significant reductions in depressive symptoms. These results will need to be validated in a sham-controlled randomized trial. The inclusion of neurophysiological measures in future trials for purposes of biological target engagement might also contribute to our understanding of underlying mechanisms and biomarker discovery.
本研究调查间歇性经颅直流电刺激治疗重度抑郁症的可行性。
在一项前瞻性开放标签研究中，招募了30名重度抑郁症患者，在2周内接受50次经颅直流电刺激（tDCS）治疗。在基线、1周和4周随访时，使用17项汉密尔顿抑郁量表（HAM-D-17）和蒙哥马利-阿斯伯格抑郁量表（MADRS）评估该tDCS方案的可行性、安全性、耐受性和初步治疗效果，治疗期间每天使用6项HAM-D（HAM-D-6）进行评估。
该方案显示出良好的可行性，保留率为93.3%，依从率为99.7%。未发生严重不良事件。最常见的副作用是刺激期间出现轻微刺痛和瘙痒感（100%）以及刺激后出现暂时性皮肤发红（100%）。此外，64.3%的参与者出现轻度刺激性接触性皮炎，大多数参与者在1周随访时症状消失，其余病例在4周随访时完全缓解；这并不影响治疗，也无需特殊治疗。HAM-D-17评分从基线时的平均21.3（标准差=3.0）降至1周时的15.3（标准差=6.3）和4周时的13.2（标准差=7.1）。以HAM-D-17衡量的抑郁症状严重程度随时间显著降低，MADRS也呈现类似趋势。HAM-D-6评分突出了反应组之间的重要差异，尤其是在治疗后期，表明1周和4周随访之间可能存在不同的反应模式。
该方案可行、安全且耐受性良好，可显著减轻抑郁症状。这些结果需要在假刺激对照随机试验中进行验证。在未来试验中纳入神经生理学测量以确定生物靶点，可能有助于我们理解潜在机制并发现生物标志物。
