Transcranial direct current stimulation for the treatment of post-stroke depression: results from a randomised, sham-controlled, double-blinded trial.
BACKGROUND
Post-stroke depression is a disabling condition occurring in about one-third of patients with stroke. Pharmacological treatments have limited efficacy and important side effects. Recently, transcranial direct current stimulation (tDCS) has shown efficacy in treating depression. This study aimed to assess the efficacy and safety of tDCS for post-stroke depression.


METHODS
48 antidepressant-free patients with post-stroke depression were randomised into two groups (active and sham tDCS). 12 30 min sessions of 2 mA anodal left/cathodal right dorsolateral prefrontal tDCS were administered over 6 weeks (once daily on weekdays for 2 weeks, then 1 session every other week). The primary outcome was the change in the Hamilton Depression Rating Scale (17-items) at 6 weeks. We employed a repeated-measures analysis of variance; the depression score was the dependent variable, and time and group were independent variables. In this intention-to-treat analysis, missing data were addressed according to the last observation carried forward and the mixed-model repeated-measures analysis methods.


RESULTS
5 patients dropped out (two in the active group). Active tDCS was significantly superior to sham at end point (mean difference, 4.7 points; SD=9.21; p<0.001). Response and remission rates were significantly higher in the active (37.5% and 20.8%, respectively) versus the sham (4.1% and 0%, respectively) group, with a number-needed-to-treat of 3 and 5, respectively.


CONCLUSIONS
This was the first controlled study to demonstrate that tDCS was safe and effective for post-stroke depression. Therefore, tDCS might be a favourable option for treating these patients.


BACKGROUND
NCT01525524; Results.
Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil.|Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
Leandro C L
LC
Valiengo
Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil.
Alessandra C
AC
Goulart
Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil.
Janaina F
JF
de Oliveira
Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil.
Isabela M
IM
Benseñor
Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil.
Paulo A
PA
Lotufo
Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil.|Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
Andre R
AR
Brunoni
D000368:Aged; D003866:Depressive Disorder / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D020521:Stroke / Q000150:complications* / Q000523:psychology; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D016896:Treatment Outcome