Waltham — May 15, 2024 — According to a review published in Harvard Review of Psychiatry , part of the Lippincott portfolio from Wolters Kluwer , certain combinations of medication or psychotherapy in conjunction with transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) are supported by clinical studies for treatment of major depressive disorder (MDD). The authors do caution that, overall, the research has important limitations.
TMS was approved by the Food and Drug Administration for treatment of MDD in 2008. It uses pulsed magnetic fields to induce an electric current in the left dorsolateral prefrontal cortex (dlPFC). tDCS conducts weaker electrical currents to the dlPFC via electrodes placed on the scalp. While not yet FDA-approved, tDCS is quite promising, especially since the equipment is portable and therefore more accessible.
Co-senior authors Tina Chou, PhD, and Darin Dougherty, MD, Director of Research and Director of the Division of Neurotherapeutics at Massachusetts General Hospital in Boston, and colleagues reviewed medical literature on whether combining TMS or tDCS with traditional MDD treatment can lead to greater symptom reduction. They searched PubMed, PsycInfo, and Cochrane Library through December 5, 2023, reviewing 58 studies that incorporated outcome measures for MDD.
Evidence-based recommendations for treating MDD with augmented neuromodulation
The reviewers found support for several augmented strategies:
More sophisticated trial designs needed
Drs. Chou, Dougherty, and co-authors discuss notable limitations of the papers they reviewed:
"Open-label trials are useful during initial, exploratory phases, or if it is not feasible to blind participants to treatments," the authors note. "In these particular studies, however, the degree to which they are used is peculiar considering the literature on neuromodulation augmentation spans nearly 20 years."
Drs. Chou and Dougherty’s group continues, "Given the potential side effects of adding medications, and the effort and time required to engage in psychotherapy, such additional interventions need to confer benefits beyond what TMS or tDCS offers alone. Crucially, randomized controlled trials are necessary to move the field forward."
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Harvard Review of Psychiatry
A Review of Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Combined with Medication and Psychotherapy for Depression
15-May-2024