ReviewClinical utility of transcranial direct current stimulation (tDCS) for treating major depression: A systematic review and meta-analysis of randomized, double-blind and sham-controlled trials
Section snippets
Search strategy
We identified articles for inclusion in this meta-analysis by:
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Screening the bibliographies of the meta-analysis by Kalu et al. (2012) as well as of all included RCTs;
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Searching MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL) and SCOPUS from July 1, 1998 (when Priori et al. (1998) published their seminal paper on tDCS using contemporary stimulation parameters) until August 20, 2012;
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Consulting the Web of Science's Citations Index Expanded for all included
Literature search
Of the 6 RCTs included in the previous meta-analysis on tDCS for MD, 5 were selected for the present investigation (Boggio et al., 2008; Fregni et al., 2006a; Loo et al., 2012, 2010; Palm et al., 2012). Also, we retrieved 37 references (after discarding duplicates) from MEDLINE, PsycINFO, EMBASE, CENTRAL and SCOPUS and 71 references (after discarding duplicates) from the Web of Science's Citations Index Expanded. Of these, 1 met our eligibility criteria (Blumberger et al., 2012). Please refer
Discussion
This is the first meta-analysis assessing the efficacy of tDCS for MD using clinically meaningful outcomes such as response and remission rates. Our results show that this neuromodulation technique is not more effective than sham tDCS. Indeed, following a mean of 10.8 ± 3.76 sessions, only 23.2% and 12.2% of depressed subjects receiving active tDCS were responders and remitters (versus 12.4% and 5.4% with sham tDCS), respectively. Furthermore, we did not find significant differences on dropout
Conclusion
The current meta-analysis, which included 200 depressed subjects, shows that the clinical utility of tDCS as treatment for MD remains unclear and that there is – at present – insufficient evidence to support the notion that tDCS is superior to placebo in achieving response and/or remission in subjects with MD. Future research should focus on the investigation of larger and more representative samples, on the potential differential efficacy of tDCS in subtypes of MD, and on how it compares to
Role of the funding source
We received no funding for this study.
Contributors
None.
Conflict of interest
Drs Berlim and Van den Eynde report no conflicts of interest. Dr Daskalakis received external funding through Neuronetics and Brainsway Inc, Aspect Medical and a travel allowance through Pfizer and Merck. Dr Daskalakis has also received speaker funding through Sepracor Inc and served on the advisory board for Hoffmann-La Roche Limited.
Acknowledgment
None.
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