Transcranial direct current stimulation: a new tool for the treatment of depression?

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that applies mild (typically 1-2 mA) direct currents via the scalp to enhance or diminish neuronal excitability. The technique has a dual function: on the one hand, it has been used to investigate the functions of various cortical regions; on the other, it has been used as an experimental treatment modality, most notably for Major Depressive Disorder (MDD). With the growing utility of tDCS in psychiatry, it is important from the vantage of safety and effectiveness to understand its underlying neurobiological mechanisms. In this respect, researchers have made significant progress in recent years, highlighting changes in resting membrane potential, spontaneous neuronal firing rates, synaptic strength, cerebral blood flow and metabolism subsequent to tDCS. We briefly review tDCS clinical trials for MDD, and then consider its mechanisms of action, identifying potential avenues for future research.

[1]  E. J. Tehovnik.  Electrical stimulation of neural tissue to evoke behavioral responses , 1996, Journal of Neuroscience Methods.

[2]  M. Bear,et al.  LTP and LTD An Embarrassment of Riches , 2004, Neuron.

[3]  A. Moriwaki.  Polarizing currents increase noradrenaline-elicited accumulation of cyclic AMP in rat cerebral cortex , 1991, Brain Research.

[4]  Walter Paulus,et al.  Dopaminergic modulation of long‐lasting direct current‐induced cortical excitability changes in the human motor cortex , 2006 .

[5]  R. Racine,et al.  Long-Term Depression and Depotentiation in the Sensorimotor Cortex of the Freely Moving Rat , 2000, The Journal of Neuroscience.

[6]  J. Rothwell,et al.  Preconditioning with transcranial direct current stimulation sensitizes the motor cortex to rapid-rate transcranial magnetic stimulation and controls the direction of after-effects , 2004, Biological Psychiatry.

[7]  Walter Paulus,et al.  Consolidation of Human Motor Cortical Neuroplasticity by D-Cycloserine , 2004, Neuropsychopharmacology.

[8]  O. Lippold,et al.  A Controlled Trial of the Therapeutic Effects of Polarization of the Brain in Depressive Illness , 1964, British Journal of Psychiatry.

[9]  M. Nitsche,et al.  Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation , 2000, The Journal of physiology.

[10]  S. Fraser,et al.  Correction , 1988, The Journal of Cell Biology.

[11]  A. Gershon,et al.  Transcranial magnetic stimulation in the treatment of depression. , 2003, The American journal of psychiatry.

[12]  M. Nitsche,et al.  Pharmacological Modulation of Cortical Excitability Shifts Induced by Transcranial Direct Current Stimulation in Humans , 2003, The Journal of physiology.

[13]  M. Nitsche,et al.  Pharmacological approach to the mechanisms of transcranial DC-stimulation-induced after-effects of human motor cortex excitability. , 2002, Brain : a journal of neurology.

[14]  Dominique Debanne,et al.  Brain plasticity and ion channels , 2003, Journal of Physiology-Paris.

[15]  P. Greengard,et al.  Enhancement of the glutamate response by cAMP-dependent protein kinase in hippocampal neurons , 1991, Science.

[16]  C. A. Terzuolo,et al.  MEASUREMENT OF IMPOSED VOLTAGE GRADIENT ADEQUATE TO MODULATE NEURONAL FIRING. , 1956, Proceedings of the National Academy of Sciences of the United States of America.

[17]  A. Priori,et al.  Myoinositol content in the human brain is modified by transcranial direct current stimulation in a matter of minutes: A 1H‐MRS study , 2008, Magnetic resonance in medicine.

[18]  Jenny C A Read,et al.  Extracellular Calcium Regulates Postsynaptic Efficacy through Group 1 Metabotropic Glutamate Receptors , 2006, The Journal of Neuroscience.

[19]  O. Lippold,et al.  Mental Changes Resulting from the Passage of Small Direct Currents Through the Human Brain , 1964, British Journal of Psychiatry.

[20]  D. Purpura,et al.  INTRACELLULAR ACTIVITIES AND EVOKED POTENTIAL CHANGES DURING POLARIZATION OF MOTOR CORTEX. , 1965, Journal of neurophysiology.

[21]  W Paulus,et al.  Regional modulation of BOLD MRI responses to human sensorimotor activation by transcranial direct current stimulation , 2001, Magnetic resonance in medicine.

[22]  Baker Ap.  Brain stem polarization in the treatment of depression. , 1970 .

[23]  E Arfai,et al.  A Controlled Study of Polarization in Depression , 1970, British Journal of Psychiatry.

[24]  L. Bindman,et al.  The action of brief polarizing currents on the cerebral cortex of the rat (1) during current flow and (2) in the production of long‐lasting after‐effects , 1964, The Journal of physiology.

[25]  M. Carney,et al.  Polarization in Depression , 1970, British Journal of Psychiatry.

[26]  Jarmo Ruohonen,et al.  Chapter 1 Background physics for magnetic stimulation , 2003 .

[27]  N Accornero,et al.  Polarization of the human motor cortex through the scalp , 1998, Neuroreport.

[28]  Frank Padberg,et al.  Skin lesions after treatment with transcranial direct current stimulation (tDCS) , 2008, Brain Stimulation.

[29]  Bruce R. Ransom,et al.  pH and brain function , 1998 .

[30]  J. C. Ramsay,et al.  Treatment of Depression with Low Voltage Direct Current , 1966, Southern medical journal.

[31]  M. Nitsche,et al.  Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex , 2005, Clinical Neurophysiology.

[32]  M. Nitsche,et al.  Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans , 2001, Neurology.

[33]  Carson C. Chow,et al.  Spontaneous action potentials due to channel fluctuations. , 1996, Biophysical journal.

[34]  Walter Heindel,et al.  Metabolic changes after repetitive transcranial magnetic stimulation (rTMS) of the left prefrontal cortex: a sham‐controlled proton magnetic resonance spectroscopy (1H MRS) study of healthy brain , 2003, The European journal of neuroscience.

[35]  Sergio P. Rigonatti,et al.  Transcranial direct stimulation and fluoxetine for the treatment of depression , 2008, European Psychiatry.

[36]  M. Herjanic,et al.  Clinical Report on a New Therapeutic Technique: Polarization , 1967, Canadian Psychiatric Association journal.

[37]  E. Bienenstock,et al.  Theory for the development of neuron selectivity: orientation specificity and binocular interaction in visual cortex , 1982, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[38]  I. Gartside,et al.  Mechanisms of Sustained Increases of Firing Rate of Neurones in the Rat Cerebral Cortex after Polarization: Reverberating Circuits or Modification of Synaptic Conductance? , 1968, Nature.

[39]  Yasuo Hori,et al.  Increase in the calcium level following anodal polarization in the rat brain , 1995, Brain Research.

[40]  A. Priori,et al.  Non‐synaptic mechanisms underlie the after‐effects of cathodal transcutaneous direct current stimulation of the human brain , 2005, The Journal of physiology.

[41]  C. Pittenger,et al.  Stress, Depression, and Neuroplasticity: A Convergence of Mechanisms , 2008, Neuropsychopharmacology.

[42]  M. Nitsche,et al.  Safety criteria for transcranial direct current stimulation (tDCS) in humans , 2003, Clinical Neurophysiology.

[43]  T. Bliss,et al.  Plasticity in the human central nervous system. , 2006, Brain : a journal of neurology.

[44]  O. Lippold,et al.  A Preliminary Account of the Clinical Effects of Polarizing the Brain in Certain Psychiatric Disorders , 1964, British Journal of Psychiatry.

[45]  M. Chesler.  Regulation and modulation of pH in the brain. , 2003, Physiological reviews.

[46]  N. Logothetis.  What we can do and what we cannot do with fMRI , 2008, Nature.

[47]  J. Rothwell,et al.  Preconditioning of Low-Frequency Repetitive Transcranial Magnetic Stimulation with Transcranial Direct Current Stimulation: Evidence for Homeostatic Plasticity in the Human Motor Cortex , 2004, The Journal of Neuroscience.

[48]  M. Noda,et al.  Facilitation of spontaneous glutamate release by antidepressant drugs in rat locus coeruleus , 2005, Neuroscience Letters.

[49]  Sergio P. Rigonatti,et al.  Treatment of major depression with transcranial direct current stimulation. , 2006, Bipolar disorders.

[50]  Á. Pascual-Leone,et al.  A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. , 2008, The international journal of neuropsychopharmacology.

[51]  Yasuo Hori,et al.  Biphasic effects of polarizing current on adenosine-sensitive generation of cyclic AMP in rat cerebral cortex , 1990, Neuroscience Letters.

[52]  M. Shapiro,et al.  The Effects of Small Electrical Currents upon Depressive Symptoms , 1974, British Journal of Psychiatry.

[53]  J. Jefferys,et al.  Effects of uniform extracellular DC electric fields on excitability in rat hippocampal slices in vitro , 2004, The Journal of physiology.

[54]  P. Amodio,et al.  Neurophysiological Investigation of Hepatic Encephalopathy , 2005, Metabolic Brain Disease.

[55]  A. Grinvald,et al.  Linking spontaneous activity of single cortical neurons and the underlying functional architecture. , 1999, Science.

[56]  Markus Zahn,et al.  Transcranial direct current stimulation: A computer-based human model study , 2007, NeuroImage.

[57]  L. Cohen,et al.  Transcranial DC stimulation (tDCS): A tool for double-blind sham-controlled clinical studies in brain stimulation , 2006, Clinical Neurophysiology.

[58]  L. Jaffe.  Electrophoresis along cell membranes , 1977, Nature.

[59]  Walter Paulus,et al.  Diminution of training-induced transient motor cortex plasticity by weak transcranial direct current stimulation in the human , 2000, Neuroscience Letters.

[60]  I. Gartside,et al.  Mechanisms of Sustained Increases of Firing Rate of Neurones in the Rat Cerebral Cortex after Polarization: Role of Protein Synthesis , 1968, Nature.

[61]  Walter Paulus,et al.  Transcranial direct current stimulation and the visual cortex , 2006, Brain Research Bulletin.

[62]  A. Priori.  Brain polarization in humans: a reappraisal of an old tool for prolonged non-invasive modulation of brain excitability , 2003, Clinical Neurophysiology.

[63]  R. Weiner.  The psychiatric use of electrically induced seizures. , 1979, The American journal of psychiatry.

[64]  Richard S. J. Frackowiak,et al.  How does transcranial DC stimulation of the primary motor cortex alter regional neuronal activity in the human brain? , 2005, The European journal of neuroscience.