TRANSCRANIAL DIRECT CURRENT STIMULATION AS AN ADJUVANT THERAPY FOR DEPRESSION TREATMENT
KEYWORDS: Transcranial direct current stimulation, Depressive disorder, Antidepressants, Neurostimulation, Cognitive therapy, Combined therapy.
INTRODUCTION: Considering the high prevalence of depressive disorders, as well as their psychological, social and biological consequences, transcranial direct current stimulation (TDCS) has been considered a potential strategy for managing this condition. This is a non-invasive neuromodulation technique based on the insertion of two flat electrodes, the anode (positive) and the cathode (negative), which are arranged in different skull regions for the application of low ampere direct current (between 0,15 - 2 mA) in sessions ranging from 10 to 20 minutes. Considering the evidence of TDCS effectiveness, the aim of the present study was to conduct a literature review on the use of this technique associated with pharmacotherapy or psychotherapies/cognitive therapies, in order to answer the following question: Is TDCS, combined with antidepressants, psychotherapy or cognitive therapies, more effective than the isolated treatment? METHODOLOGY: We performed a retrospective analysis (studies published between 2010 and 2020) using three different search strategies on the Ovid® platform. The studies were then selected according to established inclusion and exclusion criteria and comparatively analyzed. RESULTS: Nine scientific papers were selected, analyzed, discussed and theorized. We found that anodic TDCS in the prefrontal cortex (with greater evidence in the left dorsolateral subdivision) has significant antidepressant effects in the management of major depressive disorder, similar or less than sertraline and escitalopram, respectively, but superior to placebo or simulated stimulation. Furthermore, the studies indicate that the antidepressant effects of TDCS can be enhanced by the combination of treatments, mainly with sertraline. There is also evidence for a synergistic effect of TDCS and cognitive control training. CONCLUSION: Anodic TDCS in the left dorsolateral prefrontal cortex has significant antidepressant effects, similar to or less than antidepressant drugs commonly used in clinical practice, but superior to placebo or simulated stimulation. The studies analyzed indicate that the antidepressant effects of ETCC can be enhanced by the combination of treatments, mainly with sertraline. Cognitive stimulus activities can also improve antidepressant effects, although more studies, with a larger number of volunteers, can better support this conclusion. Furthermore, the increasing knowledge about ETCC, its application and effectiveness may allow in the near future a greater use of the technique as an alternative or complement to conventional treatment, considering that it is low-cost and of easy application.
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