Clinical predictors of acute response to transcranial direct current stimulation (tDCS) in major depression
Clinical predictors of acute response to transcranial direct current stimulation (tDCS) in major depression
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DOI：
10.1016/j.jad.2017.05.019
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发表时间：
2017-09-01
影响因子：
6.6
通讯作者：
Altamura, Alfredo Carlo
中科院分区：
文献类型：
--
作者：
D'Urso, Giordano;Dell'Osso, Bernardo;Altamura, Alfredo Carlo
背景：经颅直流电刺激是治疗反应差或难治性抑郁症患者的一种很有前途的神经调节干预方法。然而，人们对这种疗法的反应预测因子知之甚少。本研究旨在分析抑郁症患者治疗反应的临床预测因素。方法：收集171例抑郁症患者(包括单相和双相抑郁)的3个独立tDCS试验的临床资料，并对其进行分析，以评估治疗反应的预测因素。用汉密尔顿抑郁评定量表(HDRS)在基线和治疗后测量抑郁的严重程度和潜在的临床维度。年龄、性别和诊断(双相/单相抑郁)也被作为反应的预测因素进行了研究。线性混合模型被用来确定哪些HDRS因素与tDCS的反应有关。结果：年龄、性别和诊断与治疗反应没有任何关联。治疗后HDRS评分的降低与“认知障碍”和“迟缓”因子的基线值密切相关，而“焦虑/躯体化”因子与反应呈轻度相关。限制：开放标签设计，缺乏对照组，以及刺激方案上的微小差异。结论：单相和双相患者对tDCS的反应没有差异，表明tDCS对这两种情况都有效。“认知障碍”、“发育迟缓”和“焦虑/躯体化”被认为是tdcs反应的潜在临床预测因子。这些发现表明，对TDC的潜在应答者进行了预先选择，从而优化了这项技术的临床应用，并优化了抑郁症患者精神干预的总体成本效益。
Background: Transcranial direct current stimulation (tDCS) is a promising neuromodulation intervention for poor-responding or refractory depressed patients. However, little is known about predictors of response to this therapy. The present study aimed to analyze clinical predictors of response to tDCS in depressed patients.Methods: Clinical data from 3 independent tDCS trials on 171 depressed patients (including unipolar and bipolar depression), were pooled and analyzed to assess predictors of response. Depression severity and the underlying clinical dimensions were measured using the Hamilton Depression Rating Scale (HDRS) at baseline and after the tDCS treatment. Age, gender and diagnosis (bipolar/unipolar depression) were also investigated as predictors of response. Linear mixed models were fitted in order to ascertain which HDRS factors were associated with response to tDCS.Results: Age, gender and diagnosis did not show any association with response to treatment. The reduction in HDRS scores after tDCS was strongly associated with the baseline values of "Cognitive Disturbances" and "Retardation" factors, whilst the "Anxiety/Somatization" factor showed a mild association with the response.Limitations: Open-label design, the lack of control group, and minor differences in stimulation protocols.Conclusions: No differences in response to tDCS were found between unipolar and bipolar patients, suggesting that tDCS is effective for both conditions. "Cognitive disturbance", "Retardation", and "Anxiety/Somatization", were identified as potential clinical predictors of response to tDCS. These findings point to the pre-selection of the potential responders to tDCS, therefore optimizing the clinical use of this technique and the overall cost-effectiveness of the psychiatric intervention for depressed patients.