A New Brain-Stimulation Treatment Disappoints

Summary and Comment |
June 28, 2017

A New Brain-Stimulation Treatment Disappoints

  1. Peter Roy-Byrne, MD

Transcranial direct current stimulation was not as effective for depression as a standard, entry-level selective serotonin reuptake inhibitor and had the same adverse-effect burden.

  1. Peter Roy-Byrne, MD

Brain-stimulation treatments for depression have traditionally been considered as possible options for patients failing to respond to antidepressants. Researchers in Brazil conducted a 10-week randomized, controlled trial comparing transcranial direct current stimulation (tDCS; a largely unregulated device available to consumers) plus pill placebo, escitalopram plus sham tDCS, or double placebo in 245 depressed patients.

Escitalopram was provided at 10 mg for 3 weeks and then 20 mg afterwards; tDCS in 30-minute sessions was given 5 times weekly for 3 weeks and once weekly thereafter. The study used a noninferiority design aimed to determine whether tDCS was “as good as” escitalopram. Although both active treatments were superior to placebo, tDCS failed to meet noninferiority criteria against escitalopram (i.e., tDCS had less than half of escitalopram's superiority to placebo). Escitalopram versus tDCS had a 2.3-point difference; escitalopram versus placebo had a 5.5-point difference. The relative size of response rates (tDCS, 40%; escitalopram, 52%; placebo, 23%) reflected these findings. In another secondary analysis, escitalopram was superior to tDCS. Similar proportions of the tDCS and escitalopram groups experienced adverse effects.

Comment

This study suggests that tDCS is not as effective as escitalopram in a typical group of depressed patients who are not treatment-resistant (as shown by the response to escitalopram). Its greater efficacy compared with placebo suggests that it could be an option for depressed patients intolerant to or uninterested in medication. However, the study does not address the 20% of treatment-resistant, depressed patients, who suffer extreme distress and disability. Clinicians need more options for these patients; effective treatments are electroconvulsive therapy and transcranial magnetic stimulation. In contrast, tDCS does not represent much of an advance in treatment, especially given the cumbersome initially daily sessions.

Editor Disclosures at Time of Publication

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / Research support NIH–National Institute of Mental Health Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (Immediate Past-President)

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