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Prog Neuropsychopharmacol Biol Psychiatry. 2017 Aug 1;78:123-131. doi: 10.1016/j.pnpbp.2017.05.021. Epub 2017 May 25.

Transcranial direct-current stimulation (tDCS) for bipolar depression: A systematic review and meta-analysis.

Author information

1
INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: From Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, F-69678, France; Lyon Neuroscience Research Center, Psychiatric Disorders: From Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, F-69678, France. Electronic address: clement.donde-coquelet@ch-le-vinatier.fr.
2
University Claude Bernard Lyon 1, Villeurbanne F-69000, France.
3
AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris, Cedex 10, France; Fondation FondaMental, Créteil 94000, France.
4
Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27), University of São Paulo, São Paulo, Brazil.
5
University of Toronto, Centre for Addiction and Mental Health, Canada.
6
AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris, Cedex 10, France; Fondation FondaMental, Créteil 94000, France; Inserm, U1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France.
7
INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Psychiatric Disorders: From Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, F-69678, France; CHU Lyon, Hôpital Edouard Herriot, Department of Psychiatry Emergencies, France; Lyon Neuroscience Research Center, Psychiatric Disorders: From Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, F-69678, France.
8
AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, 75475 Paris, Cedex 10, France; Fondation FondaMental, Créteil 94000, France; Inserm, U1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France. Electronic address: pierre.a.geoffroy@gmail.com.

Abstract

OBJECTIVE:

Bipolar disorder (BD) is a severe and recurrent brain disorder that can manifest in manic or depressive episodes. Transcranial Direct Current Stimulation (tDCS) has been proposed as a novel therapeutic modality for patients experiencing bipolar depression, for which standard treatments are often inefficient. While several studies have been conducted in this patient group, there has been no systematic review or meta-analysis that specifically examines bipolar depression. We aimed to address this gap in the literature and evaluated the efficacy and tolerability of tDCS in patients fulfilling DSM-IV-TR criteria for BD I, II, or BD not otherwise specified (NOS).

METHODS:

We systematically searched the literature from April 2002 to November 2016 to identify relevant publications for inclusion in our systematic review and meta-analysis. Effect sizes for depression rating-scale scores were expressed as the standardized mean difference (SMD) before and after tDCS.

RESULTS:

Thirteen of 382 identified studies met eligibility criteria for our systematic review. The meta-analysis included 46 patients from 7 studies with depression rating-scale scores pre- and post-tDCS. Parameters of tDCS procedures were heterogeneous. Depression scores decreased significantly with a medium effect size after acute-phase of treatment (SMD 0.71 [0.25-1.18], z=3.00, p=0.003) and at the furthest endpoint (SMD 1.27 [0.57-1.97], z=3.57, p=0.0004). Six cases of affective switching under tDCS treatment protocols were observed.

CONCLUSIONS:

Depressive symptoms respond to tDCS in patients with BD. Additional studies, and particularly randomized controlled trials, are needed to clarify the effectiveness of tDCS in bipolar depression, the frequency of tDCS-emergent hypomania/mania, and which tDCS modalities are most efficient.

KEYWORDS:

Bipolar disorder; Depression; Mood disorder; Side effects; Transcranial direct current stimulation

PMID:
28552295
DOI:
10.1016/j.pnpbp.2017.05.021
[Indexed for MEDLINE]

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