Efficacy and safety of transcranial direct current stimulation as an add-on treatment for obsessive-compulsive disorder: a randomized, sham-controlled trial

Author(s)

Felipe da Silva, Renata de Melo ^[1] ; Brunoni, Andre R. ^{[2, 3, 4]} ; Goerigk, Stephan ^{[5, 6, 7]} ; Batistuzzo, Marcelo Camargo ^[1] ; da Conceicao Costa, Daniel Lucas ^[1] ; Diniz, Juliana Belo ^[1] ; Padberg, Frank ^[5] ; D'Urso, Giordano ^[8] ; Miguel, Euripedes Constantino ^[1] ; Shavitt, Roseli Gedanke ^[1]

Affiliation

^[1] Univ Sao Paulo, Sch Med, Hosp Clin, Lab Psychopathol & Psychiat Treatment L, Dept & Inst Psychiat, Obsess Compuls Spectrum Diso, Ovidio Pires de Campos 785-3, BR-05403000 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Natl Inst Biomarkers Psychiat, Dept Interdisciplinary Neuromodulat, Lab Neurosci, Ovidio Pires de Campos 785-3, BR-05403000 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Sch Med, Dept & Inst Psychiat, Ovidio Pires de Campos 785-3, BR-05403000 Sao Paulo - Brazil

^[4] Univ Sao Paulo, Sch Med, Hosp Clin, Dept Internal Med, Ovidio Pires de Campos 785-3, BR-05403000 Sao Paulo - Brazil

^[5] Ludwig Maximilians Univ Munchen, Dept Psychiat & Psychotherapy, Munich - Germany

^[6] Ludwig Maximilians Univ Munchen, Dept Psychol Methodol & Assessment, Munich - Germany

^[7] Univ Appl Sci, Hsch Fresenius, Munich - Germany

^[8] Univ Naples Federico II, Dept Neurosci Reprod Sci & Odontostomatol, Lab Neuromodulat, Unit Psychiat & Psychol, Naples - Italy

• Document type: Journal article
• Source: NEUROPSYCHOPHARMACOLOGY; v. 46, n. 5 JAN 2021.
• Web of Science Citations: 0

Abstract

Obsessive-compulsive disorder (OCD) is a frequent, disabling disorder with high rates of treatment resistance. Transcranial direct current stimulation (tDCS) is a safe, tolerable noninvasive neuromodulation therapy with scarce evidence for OCD. This double-blind, randomized, and sham-controlled study investigates the efficacy of tDCS as add-on treatment for treatment-resistant OCD (failure to respond to at least one previous pharmacological treatment). On 20 consecutive weekdays (4 weeks), 43 patients with treatment-resistant OCD underwent 30 min active or sham tDCS sessions, followed by a 8 week follow-up. The cathode was positioned over the supplementary motor area (SMA) and the anode over the left deltoid. The primary outcome was the change in baseline Y-BOCS score at week 12. Secondary outcomes were changes in mood and anxiety and the occurrence of adverse events. Response was evaluated considering percent decrease of baseline Y-BOCS scores and the Improvement subscale of the Clinical Global Impression (CGI-I) between baseline and week 12. Patients that received active tDCS achieved a significant reduction of OCD symptoms than sham, with mean (SD) Y-BOCS score changes of 6.68 (5.83) and 2.84 (6.3) points, respectively (Cohen's d: 0.62 (0.06-1.18), p = 0.03). We found no between-group differences in responders (four patients in the active tDCS and one in the sham group). Active tDCS of the SMA was not superior to sham in reducing symptoms of depression or anxiety. Patients in both groups reported mild adverse events. Our results suggest that cathodal tDCS over the SMA is an effective add-on strategy in treatment-resistant OCD. (AU)

• FAPESP's process: 11/21357-9 - Research on neural circuits and biological markers involved in obsessive-compulsive disorder using behavioral paradigms of fear and anxiety
• Grantee: Eurípedes Constantino Miguel Filho
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 14/50873-3 - INCT 2014: National Institute of Biomarkers in Neuropsychiatry
• Grantee: Wagner Farid Gattaz
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 18/10861-7 - A Phase-I bilateral project using a sham-controlled, factorial design of transcranial direct current stimulation and theta-burst stimulation to investigate the effects on multimodal assessments of prefrontal cortex functioning
• Grantee: Andre Russowsky Brunoni
• Support Opportunities: Regular Research Grants