When electricity and the brain are mentioned in the same sentence, your mind might immediately jump to disturbing images of people receiving huge shocks while covered in electrodes, strapped to tables.
But electroconvulsive therapy (ECT) treatment has developed considerably since the days depicted in “One Flew Over the Cuckoo’s Nest.” A current study at JAMA Psychiatry examines a treatment called transcranial Direct Current Stimulation (tDCS).
Could this fairly new form of electrical treatment for depression really be effective — and without the negative side effects of ECT?
This new treatment, which involves stimulating the brain with a weak electrical current, is starting to be considered as an alternative — and potentially effective — treatment for depression. tDCS, unlike traditional ECT, passes only a weak electrical current into the front of the brain through electrodes on the scalp.
Patients receive the treatment once a day for 30 minutes and remain awake and alert during the entire procedure.
Why is New Treatment for Depression So Essential?
Depression in adulthood remains a common and often under-treated condition.
Depression can occur at any age, but it typically emerges in the mid-20s. Women experience depression twice as frequently as men, and symptoms can vary from mild to severe. Major depressive disorder, which may be diagnosed when depressive symptoms last for 2 weeks or more, is understood to occur in 15 to 17 percent of the population.
Symptoms of major depressive disorder can include a depressed mood, loss of interest and enjoyment, reduced energy, increased fatigue, diminished activity and reduced concentration and attention.
These and other symptoms, particularly when prolonged, impair a person’s ability to function in day-to-day life, making effective treatment essential.
Research continues to improve our knowledge about the impact of depression on our ability to process information and the underlying processes in the brain that are associated with depressive symptoms.
With increased information, psychologists and mental health professionals have made significant progress in identifying effective treatments. A combination of cognitive behavioral therapy and medication has evolved the most effective treatment to date.
However, it is not fully understood exactly how and why antidepressants work. And despite significant advancements in medications, treating major depressive disorder remains a challenge. Although medication helps, it can be costly and produce troublesome side effects.
Recent Advances in Electrical Treatments
Noninvasive brain stimulation, such as tDCS, has been increasingly investigated for the treatment of major depression.
In previous research out of the University of New South Wales (UNSW) and the Black Dog Institute, 64 depressed participants who had not benefited from at least two other depression treatments received active or sham tDCS for 20 minutes every day for up to six weeks.
The study found up to half of depressed participants experienced substantial improvements after receiving the treatment.
In a recent clinical trial, Andre R. Brunoni, M.D., Ph.D., of the University of Sao Paulo, Brazil, and colleagues examined the safety and efficacy of electrical current therapy compared to treatment with sertraline hydrochloride for major depressive disorder (JAMA Psychiatry).
Participants included 120 patients with moderate to severe nonpsychotic unipolar major depressive disorder who were not taking antidepressant medications. A three-point change in a depressive rating scale at the six-week mark was considered clinically significant.
Participants were divided into groups to compare sertraline to tDCS or a combination of both.
In major depressive disorder “the combination of tDCS and sertraline increases the efficacy of each treatment. The efficacy and safety of tDCS and sertraline did not differ,” the study concludes.
According to the study reports as noted in JAMA Psychiatry, there was a significant difference in the depression rating scale score when comparing the combined treatment group (sertraline/active tDCS) vs. sertraline only (mean difference 8.5 points); tDCS only (mean difference, 5.9 points); and placebo/sham tDCS (mean difference 11.5 points).
Side effects of participants who received active tDCS treatment were fairly minimal, with skin redness at the treatment site and an increased potential for hypomania or mania episodes being the primary adverse effects.
More research is needed to confirm the results of this latest study. But increasingly, it looks like tDCS may offer people with depression another alternative to more traditional forms of treatment.
Andre R. Brunoni MD, PhD, Leandro Valiengo MD, Alessandra Baccaro BA, Tamires A. Zanão BS, Janaina F. de Oliveira BS, Alessandra Goulart MD, PhD, Paulo S. Boggio PhD, Paulo A. Lotufo MD, PhD, Isabela M. Benseñor MD, PhD, Felipe Fregni MD, PhD. The Sertraline vs Electrical Current Therapy for Treating Depression Clinical Study: Results From a Factorial, Randomized, Controlled Trial. (2013). Arch Gen Psychiatry, 70, 1-9. doi:10.1001/2013.jamapsychiatry.32