title: Transcranial direct current stimulation in treatment resistant depression: a randomized double-blind, placebo-controlled study.
abstract: BACKGROUND
  Anodal transcranial direct current stimulation (tDCS) of the prefrontal cortex has been proposed as therapeutic intervention in major depression. According to clinical needs, this study addresses the question whether tDCS is effective in treatment resistant major depressive episodes.
  
  
  METHODS
  Twenty-two patients with a major depressive episode were randomly assigned to a cross-over protocol comparing tDCS and placebo stimulation add-on to a stable antidepressant medication. The parameters of active tDCS were: 1 or 2 mA for 20 minutes/day, anode over the left dorsolateral prefrontal cortex, cathode over the contralateral supraorbital region. Active and placebo tDCS was applied for 2 weeks using indistinguishable DC stimulators. Patients, raters, and operators were blinded to treatment conditions.
  
  
  RESULTS
  There was no significant difference in depression scores after 2 weeks of real compared with 2 weeks of sham tDCS. Scores on the Hamilton Depression Rating Scale were reduced from baseline by 14.7% for active tDCS and 10% for placebo tDCS. In contrast, subjective mood ratings showed an increase in positive emotions after real tDCS compared with sham tDCS.
  
  
  CONCLUSIONS
  Anodal tDCS, applied for 2 weeks, was not superior to placebo treatment in patients with treatment resistant depression. However, secondary outcome measures are pointing to a positive effect of tDCS on emotions. Therefore, modified and improved tDCS protocols should be carried out in controlled pilot trials to develop tDCS towards an efficacious antidepressant intervention in therapy-resistant depression.
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Palm
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schiller
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
authors.forename: Z
authors.initials: Z
authors.lastname: Fintescu
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Obermeier
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Keeser
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Reisinger
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Pogarell
authors.affiliation: Department of Clinical Neurophysiology, Georg-August University, Goettingen, Germany.
authors.forename: M A
authors.initials: MA
authors.lastname: Nitsche
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Möller
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany. Electronic address: padberg@med.uni-muenchen.de.
authors.forename: F
authors.initials: F
authors.lastname: Padberg
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D018592:Cross-Over Studies; D003863:Depression / Q000175:diagnosis* / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015990:Placebo Effect; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome