An electric field modeling study with meta-analysis to understand the antidepressant effects of transcranial direct current stimulation (tDCS)

Autor(es)

Lais B. Razza ; Miles Wischnewski ^[2] ; Paulo Suen ^[3] ; Stefanie De Smet ; Pedro Henrique Rodrigues da Silva ^[5] ; Beatriz Catoira ; André R. Brunoni ; Marie-Anne Vanderhasselt

• Tipo de documento: Artigo Científico
• Fonte: Revista Brasileira de Psiquiatria; v. 45, n. 6, p. 518-529, 2024-02-12.

Resumo

Objective: Transcranial direct current stimulation (tDCS) has mixed effects for major depressive disorder (MDD) symptoms, partially owing to large inter-experimental variability in tDCS protocols and their correlated induced electric fields (E-fields). We investigated whether the E-field strength of distinct tDCS parameters was associated with antidepressant effect. Methods: A meta-analysis was performed with placebo-controlled clinical trials of tDCS enrolling MDD patients. PubMed, EMBASE, and Web of Science were searched from inception to March 10, 2023. Effect sizes of tDCS protocols were correlated with E-field simulations (SimNIBS) of brain regions of interest (bilateral dorsolateral prefrontal cortex [DLPFC] and bilateral subgenual anterior cingulate cortex [sgACC]). Moderators of tDCS responses were also investigated. Results: A total of 20 studies were included (21 datasets, 1,008 patients), using 11 distinct tDCS protocols. Results revealed a moderate effect for MDD (g = 0.41, 95%CI 0.18-0.64), while cathode position and treatment strategy were found to be moderators of response. A negative association between effect size and tDCS-induced E-field magnitude was seen, with stronger E-fields in the right frontal and medial parts of the DLPFC (targeted by the cathode) leading to smaller effects. No association was found for the left DLPFC and the bilateral sgACC. An optimized tDCS protocol is proposed. Conclusions: Our results highlight the need for a standardized tDCS protocol in MDD clinical trials. Registration number: PROSPERO CRD42022296246. (AU)

• Processo FAPESP: 19/06009-6 - Terapias de neuromodulação não-implantáveis: uma perspectiva para o cérebro deprimido
• Beneficiário: Geraldo Busatto Filho
• Modalidade de apoio: Auxílio à Pesquisa - Temático
• Processo FAPESP: 22/03266-0 - Investigação de avaliações de neuroimagem e modelagem de fluxo de corrente como biomarcadores de engajamento alvo e preditores de terapias convulsivas
• Beneficiário: Pedro Henrique Rodrigues da Silva
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado
• Processo FAPESP: 18/10861-7 - Avaliação multimodal dos efeitos da estimulação transcraniana por corrente contínua e estimulação theta-burst no funcionamento do córtex pré-frontal: um estudo Fase-I bilateral, placebo-controlado, fatorial
• Beneficiário: Andre Russowsky Brunoni
• Modalidade de apoio: Auxílio à Pesquisa - Regular