Depression and tDCS

What is tDCS?

tDCS stands for Transcranial Direct Current Stimulation. tDCS is a non-invasive brain based treatment that delivers a very weak electric current to the brain (Filmer, 2014). tDCS alters neuroplasticity in the brain by increasing the excitability of neurones in the brain targeted by the anode (the positive electrode), and by decreasing the excitability of neurones in the brain targeted by the cathode (the negative electrode).

Whether tDCS is an appropriate treatment for you, and parameters such as the number of treatment sessions, and the position of anode and cathode will be determined by your health professional, following a detailed assessment and QEEG brain scan, at The Perth Brain Centre.

An extensive study was published this year verifying the efficacy and safety of tDCS (Bikson, 2016). This study assures that of over 33,200 sessions included in their review of human studies there have been no serious adverse effects with use of tDCS. The most common harmless side effects can include minor short-lived discomfort such as itching, tingling or pins and needles under the electrode sites (Bikson, 2016).

Some medications and substances may also impact the efficacy of tDCS, and there are other special considerations that require an experienced approach (Nitsche, 2015). tDCS is a brain-based treatment that is best recommended and delivered by a health professional. The team at The Perth Brain Centre are always happy to discuss treatment options with individuals.

The experience of depression

Depression is not uncommon and any opportunity to talk about it helps to lift the stigma that can surround it. Depression can be a component of other significant health challenges an individual is faced with. The experience of depression is unique to the individual, but there are some common characteristics that can be described including:

  • Low mood

  • Feeling negative about yourself, others, situations and life in general

  • Withdrawing from social activities

  • Physically slowing down

  • Changes in emotional expression: anger; agitation; irritability; tearfulness

  • Changes in behaviour: increasing consumption of food, alcohol, drugs

  • Finding it difficult to get up and do even basic activities like dressing and showering

  • Thoughts of self-harm. It is essential talk of suicide is taken very seriously and treatment should be sought immediately.

How does tDCS work for depression?

tDCS works by activating a key part of the brain (known as the left dorsolateral prefrontal cortex) that is responsible for emotional regulation. The beneficial effects of tDCS on mood have been documented as far back as the 1960’s (Palm, 2016). More recent research by Professor Colleen Loo and Team at The Sydney Black Dog Institute in Australia supports the anti-depressant effects of tDCS. (Loo, 2012).

A systematic review published in April this year confirmed the findings of earlier studies showing that tDCS is as effective as anti-depressant drug treatment in primary care (Brunoni, 2016), making it an attractive option for many patients who cannot, or who do not wish, to take medication. This makes tDCS an ideal therapeutic alternative when treating depression during pregnancy (Vigod, 2014).

When you commence your tDCS treatment for depression at The Perth Brain Centre you commit to a concurrent program to capitalise on the increased excitability and plasticity of the brain regions related to your depression. New learning and repetition are key to lasting change.

The ‘window of opportunity’ following tDCS can last from 90 minutes to 24 hours. It is critically important to make the most of this time. We will personalise your program to suit your needs and this may include:

  • ‘This Way Up’ online programs developed by St Vincent’s Hospital Sydney

  • Psychology – Taryn Linacre is The Perth Brain Centre’s Registered Psychologist

  • Mindfulness meditation and visualisations

  • Meaningful and purposeful activity

  • Exercise, outdoors in green nature

  • Fun !

Reference

Baeken, C. et.al. (2016). The application of tDCS in psychiatric disorders: a brain imaging view. Socioaffective Neuroscience and Psychology, 6: 29588. Bikson et.al. (2016). Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimulation Journal. Brunoni, A.R. et.al. (2013). The sertraline vs. electrical current therapy for treating depression clinical study: results from a factorial, randomised, controlled trial. JAMA Psychiatry 70: 383-391. Brunoni, A.R. et al. (2016). Transcranial direct current stimulation for acute major depressive episodes: meta-analysis of individual patient data. The British Journal of Psychiatry Apr 2016, bjp.bp.115.164715; DOI: 10.1192/bjp.bp.115.164715 Filmer, H. et.al. (2014). Applications of transcranial direct current stimulation for understanding brain function. Trends in Neuroscience. December 2014, Vol 37, No 12. Hunter, M. et.al. (2013). Tracking the neuroplastic changes associated with transcranial direct current stimulation: a push for multimodal imaging. Frontiers in Human Neuroscience. August 2013, Vol 7, Article 495. Loo, C. et.al. (2012). Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial. The British Journal of Psychiatry, Vol 200, 52-59. Nitsche, M. et.al. (2015). Transcranial Direct Current Stimulation: Protocols and Physiological Mechanisms of Action. Textbook of Neuromodulation, Chapter 9. Palm, U. et.al. (2016). tDCS for the treatment of depression: a comprehensive review. European Archives of Psychiatry and Clinical Neuroscience. February 2016. Rigonatti, S.P. et.al. (2008). tDCS and fluoxetine for the treatment of depression. Eur Psychiatry 23: 74-76. Vigod, S. et.al. (2014). Transcranial direct current stimulation (tDCS) for treatment of major depression during pregnancy: study protocol for a pilot randomised control trial. BioMed Central, trials. Volume 15: 366. http://www.blackdoginstitute.org.au/

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