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dc.contributor.authorWang, Jingying
dc.contributor.authorLuo, Huichun
dc.contributor.authorSchülke, Rasmus
dc.contributor.authorGeng, Xinyi
dc.contributor.authorSahakian, Barbara
dc.contributor.authorWang, Shouyan
dc.date.accessioned2022-01-05T16:28:09Z
dc.date.available2022-01-05T16:28:09Z
dc.date.issued2021-12-17
dc.date.submitted2021-07-12
dc.identifier.issn1741-7015
dc.identifier.others12916-021-02181-4
dc.identifier.other2181
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/332032
dc.description.abstractBACKGROUND: Transcranial direct current stimulation (tDCS) has shown mixed results for depression treatment. The efficacies of tDCS combination therapies have not been investigated deliberately. This review aims to evaluate the clinical efficacy of tDCS as a monotherapy and in combination with medication, psychotherapy, and ECT for treating adult patients with major depressive disorder (MDD) and identified the factors influencing treatment outcome measures (i.e. depression score, dropout, response, and remission rates). METHODS: The systematic review was performed in PubMed/Medline, EMBASE, PsycINFO, Web of Sciences, and OpenGrey. Two authors performed independent literature screening and data extraction. The primary outcomes were the standardized mean difference (SMD) for continuous depression scores after treatment and odds ratio (OR) dropout rate; secondary outcomes included ORs for response and remission rates. Random effects models with 95% confidence intervals were employed in all outcomes. The overall effect of tDCS was investigated by meta-analysis. Sources of heterogeneity were explored via subgroup analyses, meta-regression, sensitivity analyses, and assessment of publication bias. RESULTS: Twelve randomised, sham-controlled trials (active group: N = 251, sham group: N = 204) were included. Overall, the integrated depression score of the active group after treatment was significantly lower than that of the sham group (g = - 0.442, p = 0.017), and further analysis showed that only tDCS + medication achieved a significant lower score (g = - 0.855, p < 0.001). Moreover, this combination achieved a significantly higher response rate than sham intervention (OR = 2.7, p = 0.006), while the response rate remained unchanged for the other three therapies. Dropout and remission rates were similar in the active and sham groups for each therapy and also for the overall intervention. The meta-regression results showed that current intensity is the only predictor for the response rate. None of publication bias was identified. CONCLUSION: The effect size of tDCS treatment was obviously larger in depression score compared with sham stimulation. The tDCS combined selective serotonin re-uptake inhibitors is the optimized therapy that is effective on depression score and response rate. tDCS monotherapy and combined psychotherapy have no significant effects. The most important parameter for optimization in future trials is treatment strategy.
dc.languageen
dc.publisherSpringer Science and Business Media LLC
dc.subjectResearch Article
dc.subjectTranscranial direct current stimulation
dc.subjectMajor depressive disorder
dc.subjectTreatment strategy
dc.subjectCombination therapy
dc.subjectAntidepressant
dc.subjectSystematic review
dc.subjectMeta-analysis
dc.titleIs transcranial direct current stimulation, alone or in combination with antidepressant medications or psychotherapies, effective in treating major depressive disorder? A systematic review and meta-analysis.
dc.typeArticle
dc.date.updated2022-01-05T16:28:08Z
prism.issueIdentifier1
prism.publicationNameBMC Med
prism.volume19
dc.identifier.doi10.17863/CAM.79479
dcterms.dateAccepted2021-11-08
rioxxterms.versionofrecord10.1186/s12916-021-02181-4
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
dc.contributor.orcidSahakian, Barbara [0000-0001-7352-1745]
dc.identifier.eissn1741-7015
pubs.funder-project-idministry of science and technology of the people's republic of china (No. 2018YFC1705800)
pubs.funder-project-idchinese ministry of education (No. B18015)
pubs.funder-project-idscience and technology commission of shanghai municipality (No. 2018SHZDZX01, No. 2017SHZDZX01, No. 2021SHZDZX0103)
pubs.funder-project-idshanghai sailing program (No. 19YF1403600)
pubs.funder-project-idnational natural science foundation of china (No. 81901153)
cam.issuedOnline2021-12-17


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