Cognitive changes after tDCS and escitalopram treatment in major depressive disorder: Results from the placebo-controlled ELECT-TDCS trial

Marina L Moreno; Stephan A Goerigk; Laiss Bertola; Claudia K Suemoto; Lais B Razza; Adriano H Moffa; Beatriz P Veronezi; Luara Tort; Barbara S Nogueira; Wagner F Gattaz; Renerio Fraguas; Frank Padberg; Paulo A Lotufo; Isabela M Benseñor; Andre R Brunoni

doi:10.1016/j.jad.2019.12.009

Cognitive changes after tDCS and escitalopram treatment in major depressive disorder: Results from the placebo-controlled ELECT-TDCS trial

J Affect Disord. 2020 Feb 15:263:344-352. doi: 10.1016/j.jad.2019.12.009. Epub 2019 Dec 5.

Authors

Affiliations

¹ Departamento de Clínica Médica, Faculdade de Medicina da USP & Hospital Universitário da USP, São Paulo, Brazil; Departamento e Instituto de Psiquiatria, Faculdade de Medicina da USP & Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Universidade de São Paulo, São Paulo, Brazil.
² Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Leopoldstraße 13, 80802, Munich, Germany; Hochschule Fresenius, University of Applied Sciences, Infanteriestraße 11A, 80797, Munich, Germany.
³ Departamento de Clínica Médica, Faculdade de Medicina da USP & Hospital Universitário da USP, São Paulo, Brazil.
⁴ Departamento e Instituto de Psiquiatria, Faculdade de Medicina da USP & Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Universidade de São Paulo, São Paulo, Brazil.
⁵ Departamento e Instituto de Psiquiatria, Faculdade de Medicina da USP & Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Universidade de São Paulo, São Paulo, Brazil; School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia.
⁶ Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
⁷ Departamento de Clínica Médica, Faculdade de Medicina da USP & Hospital Universitário da USP, São Paulo, Brazil; Departamento e Instituto de Psiquiatria, Faculdade de Medicina da USP & Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Universidade de São Paulo, São Paulo, Brazil. Electronic address: brunoni@usp.br.

PMID: 31969264
DOI: 10.1016/j.jad.2019.12.009

Abstract

Background: Cognitive deficits in major depressive disorder (MDD) are associated with low quality of life and higher suicide risk. Antidepressant drugs have modest to null effects in improving such deficits. Therefore, we investigated the cognitive effects of transcranial direct current stimulation (tDCS), which is a promising antidepressant non-pharmacological intervention, in MDD.

Methods: An exploratory analysis on cognitive performance was conducted in 243 depressed patients from the Escitalopram vs. Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS), a sham-controlled study comparing the efficacy of tDCS vs. escitalopram. A neuropsychological battery was applied at baseline and endpoint (10 weeks of treatment) to create composite cognitive scores (processing speed, working memory, and verbal fluency). Linear mixed regression models were used to evaluate changes according to intervention groups, adjusted for confounding variables (age, years of schooling, gender, and benzodiazepine use) and depression improvement.

Results: No cognitive deterioration was observed in any group. Patients receiving tDCS presented reduced practice gains compared to placebo in processing speed. In patients receiving escitalopram vs. placebo and in the subgroup of clinical responders (>50% depression improvement from baseline), those receiving tDCS vs. placebo presented increased performance in verbal fluency. No significant differences between tDCS and escitalopram groups were detected.

Limitations: Absence of healthy controls.

Conclusion: Prefrontal tDCS did not lead to cognitive deficits in depressed patients, although it reduced practice effects in processing speed. tDCS responders presented increased performance in verbal fluency. Further investigation of tDCS cognitive effects in depression is warranted.

Keywords: Cognition; Dorsolateral prefrontal cortex; Major depressive disorder; Psychiatry; Safety; Transcranial direct current stimulation (tDCS).

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Citalopram* / therapeutic use
Cognition*
Depressive Disorder, Major* / drug therapy
Double-Blind Method
Humans
Mental Processes
Prefrontal Cortex
Quality of Life
Selective Serotonin Reuptake Inhibitors* / therapeutic use
Transcranial Direct Current Stimulation* / adverse effects
Transcranial Direct Current Stimulation* / methods
Treatment Outcome

Substances

Serotonin Uptake Inhibitors
Citalopram