Unlocking Dual Brain Stimulation: Effective Methods to Combat Depression

TOPLINE:

A new study found that combining transcranial direct current stimulation (tDCS) with repetitive transcranial magnetic stimulation (rTMS) reduced symptoms of major depressive disorder (MDD) more effectively than using either treatment alone.

METHODOLOGY:

• Researchers conducted a double-blind, sham-controlled trial from 2021 to 2023 at three hospitals in China, involving 240 participants with MDD (average age 32.5 years, 58% women).
• Participants were divided into four treatment groups: active tDCS + active rTMS, sham tDCS + active rTMS, active tDCS + sham rTMS, and sham tDCS + sham rTMS. Each received treatments five times a week for 2 weeks.
• tDCS was applied for 20 minutes at 2 mA, while rTMS included 1600 pulses at 10 Hz, targeting the left dorsolateral prefrontal cortex. Sham treatments mimicked sounds without actual stimulation.
• The main measure was the change in the 24-item Hamilton Depression Rating Scale (HDRS-24) score from baseline to week 2.
• Secondary measures included HDRS-24 score changes at week 4, remission rates (HDRS-24 score ≤ 9), response rates (≥ 50% reduction in HDRS-24 score), and adverse events.

TAKEAWAY:

• The active tDCS + active rTMS group showed the most significant reduction in HDRS-24 scores (18.33 ± 5.39) at week 2 compared to the other groups.
• Response rates at week 2 were highest in the active tDCS + active rTMS group (85%), compared to 30% in active tDCS + sham rTMS and 32% in sham tDCS + sham rTMS.
• By week 4, the remission rate reached 83% in the active tDCS + active rTMS group, significantly higher than other groups.
• All treatments were well tolerated, with no serious adverse events reported.

IN PRACTICE:

This study is the first to assess the safety and effectiveness of combining tDCS and rTMS for treating depression. Future research should explore how this combined approach works and how to optimize treatment parameters.

SOURCE:

The study was led by Dongsheng Zhou, MD, at Ningbo Kangning Hospital, China. It was published on November 13 in JAMA Network Open.

LIMITATIONS:

The treatment duration of 10 sessions may not have allowed tDCS and rTMS to show their full potential. Additionally, the study did not regulate participants’ antidepressant medications. The lack of randomization and adjustment for center effects could have affected the results.

DISCLOSURES:

This research received multiple grants, including support from the Natural Science Foundation of Zhejiang Province and other health programs. The authors indicated no conflicts of interest.