Transcranial Electrical Stimulation Associated With Positive Outcomes in Depressive Patients With and Without Comorbidities
Transcranial electrical stimulation (tES) was well-tolerated and associated with positive outcomes among patients with major depressive disorder (MDD), depression with psychiatric comorbidities (DPC), and depression with medical comorbidities (DMC), according to a recent review and meta-analysis published in JAMA Network Open.
“This analysis adds to prior meta-analyses on noninvasive brain stimulation by focusing on tES treatments for depressive disorders with and without comorbidities,” wrote Caili Ren, MD, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, and study coauthors. “Our results align with previous meta-analyses on transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) for MDD, confirming their findings through sensitivity analyses.”
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The researchers selected 114 study groups from 88 randomized control trials (RCTs) evaluating the treatment effects of tDCS, tACS, or transcranial random noise stimulation (tRNS) as compared to sham or other treatment modalities on patients with MDD, DPC, or DMC (n= 5522). Of the included study groups, 104 from 79 RCTs evaluated tDCS, 7 from 6 RCTs evaluated tACS, and 3 from 3 RCTS evaluated tRNS. Primary outcomes included antidepressant response, depression severity, and remission rates. The researchers calculated standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for categorical outcomes. They also assessed the quality of evidence (QOE) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.
The analysis found that tDCS was associated with improved depression in patients with DMC (SMD = −1.05; 95% CI, −1.70 to −0.40; I2 = 90%; very low QOE) and DPC (SMD = −0.88, 95% CI, −1.40 to −0.36; I2 = 84%, low QOE), but did not have a significant impact on MDD patients. However, a combination of tDCS and medication was associated with reduced depressive symptoms and increased response in MDD (SMD = −0.51; 95% CI, −0.90 to −0.13; moderate QOE; OR, 2.25; 95% CI, 1.08 to 4.65; high QOE). tACS was also associated with an improvement in MDD symptoms (SMD = −0.58; 95% CI, −0.96 to −0.20; high QOE) and response rates (OR, 2.07; 95% CI, 1.34 to 3.19; high QOE). Meanwhile, tRNS did not demonstrate significant improvements across any of the diagnostic groups.
The authors noted that the treatments were well-tolerated, and the reported adverse effects (AEs) were mild to moderate. “Serious AEs were rare and occurred primarily with tDCS studies, often when combined with antidepressants,” the authors wrote. “These findings align with prior evidence suggesting that active tES, particularly tDCS, is safe (although mild to moderate AEs are more common) and well-tolerated compared with sham.”
However, further research is needed to develop a more comprehensive safety profile of tES treatments, as the authors noted that more than 40% of the included studies did not report EA data.
