Noninvasive, electric stimulation of the brain appears to help the first stage of treatment especially in combination with the antidepressant, a double-blind trial showed.

Six weeks of daily transcranial direct current stimulation sessions reduced depression scores roughly the exact same as sertraline, Andre R. Brunoni, MD, PhD, of the University of Sao Paulo, Brazil, and colleagues reported online in JAMA Psychiatry.

The two jointly brought scores down by an average 8.5 points more than sertraline alone on a depression rating scale, and by 5.9 points more than direct current stimulation alone.

A 3-point difference on that Montgomery-Asberg Depression Rating Scale (MADRS) is considered clinically useful.

“Noninvasive brain stimulant has become an established treatment for the treatment of depression,” Brunoni and coworkers wrote.

The poor electrical current used across big electrodes on the scalp may function by fostering activity within an region of the brain known to be hypoactive in depression, with all the edge of lacking the same adverse effects and contraindications the group pointed out.

The apparatus also is comparatively inexpensive, so it could be a “cost effective choice for areas with low resources where the prevalence of major depressive disorder is high, such as most developing countries,” they added.

But, the treatment is less practical than taking a pill, plus it is unclear how its results would hold up in the maintenance phase.

“Even if transcranial direct current stimulation becomes accessible for inhouse use, it would still require 20- to 30-minute daily sessions for many weeks,” Brunoni’s group wrote.

Their Sertraline vs Electric Current Therapy for Treating Depression Clinical Study (SELECT TDCS) compared in a two-by-two design treatment with 6 weeks of sertraline at 50 mg daily or placebo and 2-mA anodal left/cathodal right prefrontal transcranial direct current stimulation (30-minute sessions each weekday plus two extra sessions every other week) or sham.

It included 120 antidepressant-naive patients with average-to-severe major depressive disorder but no bipolar or psychotic component, seen in just one outpatient center within an academic setting in Sao Paulo. The cohort had brief duration of the index episode and a comparatively low level of refractoriness.

The one thing that has been not better than inactive therapy at the end of the 6-week interval was sertraline alone, with a mean difference of 2.9 points versus placebo.

The explanation may happen to be that 50 milligrams per day was a low dose for a few participants, though there have been negative trials with sertraline in major depressive disorder, the researchers pointed out.

Transcranial direct current stimulation improved MADRS score by 5.6 points over sham.

The combination of the two appeared to function fastest, as that was the sole group with an important change in score at week two. Factorial evaluation suggested the initial effect was driven chiefly from the electric stimulation treatment.

The two seemed to be additive rather than synergistic.

Clinical response with at least a 50 percent reduction in baseline MADRS score was significantly more common with transcranial direct current stimulation or mix treatment than with placebo (43 percent and 63 percent versus 17 percent).

Remission, with MADRS score dropping to 10 points or less, happened in 40 percent of the electric stimulation group and 47 percent of the combo group, which were both significantly better in relation to the 13 percent speed with placebo.

Sertraline induced remission in 30 percent, although this difference did not reach value.

No negative cognitive effects were found with transcranial direct current stimulation, though skin redness was common by the end of week two.

Of the seven episodes of treatment-emergent mania or hypomania, five were including one serious manic episode requiring pharmacologic intervention.

Hypomania induction or mania could not be dissimilar with transcranial direct current stimulation as with antidepressants, so such events need careful observation in future trials, Brunoni’s group noted.

Further research is required into longer-term effects and into use they included.

Their trial comprises an open-label period for sham nonresponders to cross over to 10 days of active transcranial direct current stimulation, along with a 6-month follow up period for folks who reacted in the very first 6 weeks to treatment that is active.

Source: A Little Juice to the Brain Eases Depression