Prefrontal transcranial direct current stimulation (tDCS) as treatment for major depression: study design and methodology of a multicenter triple blind randomized placebo controlled trial (DepressionDC)

• Published in: European archives of psychiatry and clinical neuroscience 2017-12, Vol.267 (8), p.751-766
• Main Authors: Padberg, Frank, Kumpf, Ulrike, Mansmann, Ulrich, Palm, Ulrich, Plewnia, Christian, Langguth, Berthold, Zwanzger, Peter, Fallgatter, Andreas, Nolden, Jana, Burger, Max, Keeser, Daniel, Rupprecht, Rainer, Falkai, Peter, Hasan, Alkomiet, Egert, Silvia, Bajbouj, Malek
• Format: Article
• Language: English
• Subjects: Adult; Antidepressants; Clinical trials; Cognition; Combined Modality Therapy; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - therapy; Double-Blind Method; Electrical stimulation of the brain; ESB; Female; Functional magnetic resonance imaging; Genetic screening; Humans; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Mental depression; Middle Aged; Neurosciences; Original Paper; Outcome and Process Assessment (Health Care) - methods; Placebos; Prefrontal Cortex; Psychiatry; Quality control; Research Design; Serotonin uptake inhibitors; Serotonin Uptake Inhibitors - administration & dosage; Serotonin Uptake Inhibitors - pharmacology; Structure-function relationships; Transcranial Direct Current Stimulation - methods
• ISSN: 0940-1334; 1433-8491
• DOI: 10.1007/s00406-017-0769-y

Transcranial direct current stimulation (tDCS) has been proposed as novel treatment for major depressive disorder (MDD) based on clinical pilot studies as well as randomized controlled monocentric trials. The DepressionDC trial is a triple-blind (blinding of rater, operator and patient), randomized, placebo controlled multicenter trial investigating the efficacy and safety of prefrontal tDCS used as additive treatment in MDD patients who have not responded to selective serotonin reuptake inhibitors (SSRI). At 5 study sites, 152 patients with MDD receive a 6-weeks treatment with active tDCS (anode F3 and cathode F4, 2 mA intensity, 30 min/day) or sham tDCS add-on to a stable antidepressant medication with an SSRI. Follow-up visits are at 3 and 6 months after the last tDCS session. The primary outcome measure is the change of the Montgomery-Asberg Depression Rating Scale (MADRS) scores at week 6 post-randomisation compared to baseline. Secondary endpoints also cover other psychopathological domains, and a comprehensive safety assessment includes measures of cognition. Patients undergo optional investigations comprising genetic testing and functional magnetic resonance imaging (fMRI) of structural and functional connectivity. The study uses also an advanced tDCS technology including standard electrode positioning and recording of technical parameters (current, impedance, voltage) in every tDCS session. Aside reporting the study protocol here, we present a novel approach for monitoring technical parameters of tDCS which will allow quality control of stimulation and further analysis of the interaction between technical parameters and clinical outcome. The DepressionDC trial will hopefully answer the important clinical question whether prefrontal tDCS is a safe and effective antidepressant intervention in patients who have not sufficiently responded to SSRIs. Trial registry : ClinicalTrials.gov Identifier NCT0253016.