Efficacy and Safety of Transcranial Direct Current Stimulation (tDCS) in the Treatment of Bipolar Depression: A Systematic Review

Document Type : Original Article

Authors

Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran

Abstract

Since standard treatments often show limited efficacy in the treatment of bipolar depressive disorder, the use of non-invasive stimulation techniques such as transcranial direct current stimulation (tDCS) (tDCS) can be promising. The aim of the present study is to systematically review studies on the effectiveness of tDCS on bipolar depression. This research was conducted to investigate the effectiveness of this method in the treatment of bipolar depression. 154 articles were retrieved from Google Scholar, PubMed, Scopus, and Web of Science databases, among which 19 articles were relevant to the topic. Finally, 13 studies were excluded and 6 studies were included for investigation. In all these studies, the anode electrode in the left dorsolateral prefrontal cortex (DLPFC-F3) and the cathode electrode in the right dorsolateral prefrontal cortex (DLPFC-F4) were selected as stimulation areas. The results of the extracted articles indicated the tDCS is a safe method.  In summary, the results of the present study indicate that tDCS is a promising approach to treating symptoms of bipolar depression. The findings of the present study are significant from two aspects: firstly, they demonstrate the effectiveness of tDCS in reducing depressive symptoms in these patients; secondly, the lack of a long follow-up period to assess the durability of the treatment effects and the use of small sample sizes in experimental groups were the main limitations of the reviewed studies. Therefore, future research is encouraged to take this issue into consideration when designing interventions.

Keywords

References

Agboada, D., Mosayebi-Samani, M., Kuo, M.-F., & Nitsche, M. A. (2020). Induction of long-term potentiation-like plasticity in the primary motor cortex with repeated anodal transcranial direct current stimulation–better effects with intensified protocols? Brain stimulation, 13(4), 987-997. doi:10.1016/j.brs.2020.04.009
Alizadehgoradel, J. (2023). Modification of attentional bias and reduced craving from combined mindfulness+ tDCS therapy in methamphetamine addiction: A randomized, sham-controlled, single-blinded clinical trial. Journal of Research in Psychopathology, 4(13), 6-15. doi: 10.22098/JRP.2023.12028.1152
Alizadehgoradel, J., Nejati, V., Movahed, F. S., Imani, S., Taherifard, M., Mosayebi-Samani, M., Vicario, C. M., Nitsche, M. A., & Salehinejad, M. A. (2020). Repeated stimulation of the dorsolateral-prefrontal cortex improves executive dysfunctions and craving in drug addiction: A randomized, double-blind, parallel-group study. Brain stimulation, 13(3), 582-593. doi: 10.1016/j.brs.2019.12.028.
Alizadehgoradel, J., Pouresmali, A., & Taherifard, M. (2023). Safety and Efficacy of an Intensified and Repeated Transcranial Direct Current Stimulation Targeting Supplementary Motor Area and Dorsolateral Prefrontal Cortex in Trichotillomania (Hair Pulling Disorder): A Case Report. Clinical Psychopharmacology and Neuroscience: the Official Scientific Journal of the Korean College of Neuropsychopharmacology, 22(1), 188-193. doi:10.9758/cpn.23.1082.
Alizadehgoradel, J., Taherifard, M., & Vanderhasselt, M.-A. (2023). Safety and efficacy of intensified electrical stimulation targeting dorsolateral prefrontal cortex for the treatment of gambling disorder associated with online sports betting: a case report. International Gambling Studies, 1-10. doi: 10.1080/14459795.2023.2240873
American Psychiatric Association, D., & Association, A. P. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5). American psychiatric association Washington, DC. doi:10.1176/appi.books.
Arshadi, S., Nokani, M., Asgari, M., & Sepahvand, T. (2022). The effectiveness of cognitive rehabilitation of inhibitory control, transcranial direct current stimulation and combination of inhibitory control and transcranial direct current stimulation on inhibitory control and working memory in children with attention deficit disorder/hyperactivity. Journal of Research in Psychopathology, 3(10), 35-47. doi:10.22098/JRP.2022.10977.1108
Brunoni, A., Ferrucci, R., Bortolomasi, M., Vergari, M., Tadini, L., Boggio, P., Giacopuzzi, M., Barbieri, S., & Priori, A. (2011). Transcranial direct current stimulation (tDCS) in unipolar vs. bipolar depressive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35(1), 96-101. doi:10.1016/j.pnpbp.2010.09.010.
Brunoni, A. R., Ferrucci, R., Bortolomasi, M., Scelzo, E., Boggio, P., Fregni, F., Dell’Osso, B., Giacopuzzi, M., Altamura, A., & Priori, A. (2013). Interactions between transcranial direct current stimulation (tDCS) and pharmacological interventions in the Major Depressive Episode: findings from a naturalistic study. European Psychiatry, 28(6), 356-361. doi: 10.1016/j.eurpsy.2012.09.001.
Brunoni, A. R., Moffa, A. H., Fregni, F., Palm, U., Padberg, F., Blumberger, D. M., Daskalakis, Z. J., Bennabi, D., Haffen, E., & Alonzo, A. (2016). Transcranial direct current stimulation for acute major depressive episodes: meta-analysis of individual patient data. The British Journal of Psychiatry, 208(6), 522-531. doi: 10.1192/bjp.bp.115.164715.
Chai, X. J., Whitfield-Gabrieli, S., Shinn, A. K., Gabrieli, J. D., Nieto Castañón, A., McCarthy, J. M., Cohen, B. M., & Öngür, D. (2011). Abnormal medial prefrontal cortex resting-state connectivity in bipolar disorder and schizophrenia. Neuropsychopharmacology, 36(10), 2009-2017. doi: 10.1038/npp.2011.88.
Donde, C., Amad, A., Nieto, I., Brunoni, A. R., Neufeld, N. H., Bellivier, F., Poulet, E., & Geoffroy, P.-A. (2017). Transcranial direct-current stimulation (tDCS) for bipolar depression: A systematic review and meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 78, 123-131. doi: 10.1016/j.pnpbp.2017.05.021.
Dondé, C., Neufeld, N. H., & Geoffroy, P. A. (2018). The impact of transcranial direct current stimulation (tDCS) on bipolar depression, mania, and euthymia: a systematic review of preliminary data. Psychiatric Quarterly, 89(4), 855-867. doi: 10.1007/s11126-018-9584-5.
Frey, B. N., Stanley, J. A., Nery, F. G., Serap Monkul, E., Nicoletti, M. A., Chen, H. H., Hatch, J. P., Caetano, S. C., Ortiz, O., & Kapczinski, F. (2007). Abnormal cellular energy and phospholipid metabolism in the left dorsolateral prefrontal cortex of medication‐free individuals with bipolar disorder: an in vivo1H MRS study. Bipolar disorders, 9, 119-127. doi: 10.1111/j.1399-5618.2007.00454.x.
Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561 1572. doi:10.1016/S0140-6736(15)00241-X.
Grimm, S., Beck, J., Schuepbach, D., Hell, D., Boesiger, P., Bermpohl, F., Niehaus, L., Boeker, H., & Northoff, G. (2008). Imbalance between left and right dorsolateral prefrontal cortex in major depression is linked to negative emotional judgment: an fMRI study in severe major depressive disorder. Biological psychiatry, 63(4), 369-376. doi:10.1016/j.biopsych.2007.05.033.
Hou, L., Bergen, S. E., Akula, N., Song, J., Hultman, C. M., Landén, M., Adli, M., Alda, M., Ardau, R., & Arias, B. (2016). Genome-wide association study of 40,000 individuals identifies two novel loci associated with bipolar disorder. Human molecular genetics, 25(15), 3383-3394. doi:10.1093/hmg/ddw181.
Jafari, E., Alizadehgoradel, J., Koluri, F. P., Nikoozadehkordmirza, E., Refahi, M., Taherifard, M., Nejati, V., Hallajian, A.-H., Ghanavati, E., & Vicario, C. M. (2021). Intensified electrical stimulation targeting lateral and medial prefrontal cortices for the treatment of social anxiety disorder: A randomized, double-blind, parallel-group, dose-comparison study. Brain stimulation, 14(4), 974-986. doi:10.1016/j.brs.2021.06.005.
Kennedy, D. N., Lange, N., Makris, N., Bates, J., Meyer, J., & Caviness Jr, V. S. (1998). Gyri of the human neocortex: an MRI-based analysis of volume and variance. Cerebral Cortex (New York, NY: 1991), 8(4), 372-384. doi:10.1093/cercor/8.4.372.
Lin, Y.-Y., Chang, C.-C., Huang, C. C.-Y., Tzeng, N.-S., Kao, Y.-C., & Chang, H.-A. (2021). Efficacy and neurophysiological predictors of treatment response of adjunct bifrontal transcranial direct current stimulation (tDCS) in treating unipolar and bipolar depression. Journal of Affective Disorders, 280, 295-304. doi:10.1016/j.jad.2020.11.030.
Mardani, P., Zolghadriha, A., Dadashi, M., Javdani, H., & Mousavi, S. E. (2021). Effect of medication therapy combined with transcranial direct current stimulation on depression and response inhibition of patients with bipolar disorder type I: a clinical trial. BMC psychiatry, 21(1), 1-9. doi:10.1186/s12888-021-03592-6.
McClintock, S. M., Martin, D. M., Lisanby, S. H., Alonzo, A., McDonald, W. M., Aaronson, S. T., Husain, M. M., O'Reardon, J. P., Weickert, C. S., & Mohan, A. (2020). Neurocognitive effects of transcranial direct current stimulation (tDCS) in unipolar and bipolar depression: Findings from an international randomized controlled trial. Depression and anxiety, 37(3), 261-272. doi:10.1002/da.22988.
Monte-Silva, K., Kuo, M.-F., Hessenthaler, S., Fresnoza, S., Liebetanz, D., Paulus, W., & Nitsche, M. A. (2013). Induction of late LTP-like plasticity in the human motor cortex by repeated non-invasive brain stimulation. Brain stimulation, 6(3), 424-432. doi:10.1016/j.brs.2012.04.011.
Müller-Oerlinghausen, B., Berghöfer, A., & Bauer, M. (2002). Bipolar disorder. The Lancet, 359(9302), 241-247. doi:10.1016/S0140-6736(02)07450-0.
Nitsche, M. A., Cohen, L. G., Wassermann, E. M., Priori, A., Lang, N., Antal, A., Paulus, W., Hummel, F., Boggio, P. S., & Fregni, F. (2008). Transcranial direct current stimulation: state of the art 2008. Brain stimulation, 1(3), 206-223. doi:10.1016/j.brs.2008.06.004.
O'Donovan, C., & Alda, M. (2020). Depression preceding diagnosis of bipolar disorder. Frontiers in psychiatry, 11, 500. doi:10.3389/fpsyt.2020.00500.
Phillips, M. L., & Kupfer, D. J. (2013). Bipolar disorder diagnosis: challenges and future directions. The Lancet, 381(9878), 1663-1671. doi:10.1016/S0140-6736(13)60989-7.
Rodríguez‐Cano, E., Alonso‐Lana, S., Sarró, S., Fernández‐Corcuera, P., Goikolea, J. M., Vieta, E., Maristany, T., Salvador, R., McKenna, P. J., & Pomarol‐Clotet, E. (2017). Differential failure to deactivate the default mode network in unipolar and bipolar depression. Bipolar disorders, 19(5), 386-395. doi:10.1111/bdi.12517.
Rroji, O., van Kuyck, K., Nuttin, B., & Wenderoth, N. (2015). Anodal tDCS over the primary motor cortex facilitates long-term memory formation reflecting use-dependent plasticity. PLoS One, 10(5), e0127270. doi:10.1371/journal.pone.0127270.
Sampaio-Junior, B., Tortella, G., Borrione, L., Moffa, A. H., Machado-Vieira, R., Cretaz, E., da Silva, A. F., Fraguas, R., Aparício, L. V., & Klein, I. (2018). Efficacy and safety of transcranial direct current stimulation as an add-on treatment for bipolar depression: a randomized clinical trial. JAMA psychiatry, 75(2), 158-166. doi:10.1001/jamapsychiatry.2017.4040.
Zhang, X., Zhang, R., Lv, L., Qi, X., Shi, J., & Xie, S. (2022). Correlation between cognitive deficits and dorsolateral prefrontal cortex functional connectivity in first-episode depression. Journal of Affective Disorders, 312, 152-158. doi:10.1016/j.jad.2022.06.024 

Files

Share

How to cite

Statistics