Distinct trajectories of response to prefrontal tDCS in major depression: results from a 3-arm randomized controlled trial
- 1 March 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Neuropsychopharmacology
- Vol. 46 (4), 774-782
- https://doi.org/10.1038/s41386-020-00935-x
Abstract
Transcranial direct current stimulation (tDCS) is a safe, effective treatment for major depressive disorder (MDD). While antidepressant effects are heterogeneous, no studies have investigated trajectories of tDCS response. We characterized distinct improvement trajectories and associated baseline characteristics for patients treated with prefrontal tDCS, an active pharmacotherapy (escitalopram), and placebo. This is a secondary analysis of a randomized, non-inferiority, double-blinded trial (ELECT-TDCS, N = 245). Participants were diagnosed with an acute unipolar, nonpsychotic, depressive episode, and presented Hamilton Depression Rating Scale (17-items, HAM-D) scores >= 17. Latent trajectory modeling was used to identify HAM-D response trajectories over a 10-week treatment. Top-down (hypothesis-driven) and bottom-up (data-driven) methods were employed to explore potential predictive features using, respectively, conservatively corrected regression models and a cross-validated stability ranking procedure combined with elastic net regularization. Three trajectory classes that were distinct in response speed and intensity (rapid, slow, and no/minimal improvement) were identified for escitalopram, tDCS, and placebo. Differences in response and remission rates were significant early for all groups. Depression severity, use of benzodiazepines, and age were associated with no/minimal improvement. No significant differences in trajectory assignment were found in tDCS vs. placebo comparisons (38.3, 34, and 27.6%; vs. 23.3, 43.3, and 33.3% for rapid, slow, and no/minimal trajectories, respectively). Additional features are suggested in bottom-up analyses. Summarily, groups treated with tDCS, escitalopram, and placebo differed in trajectory class distributions and baseline predictors of response. Our results might be relevant for designing further studies.Funding Information
- Bundesministerium für Bildung und Forschung (01EE1403E)
This publication has 45 references indexed in Scilit:
- Pharmaco-transcranial magnetic stimulation studies of motor excitabilityHandbook of Clinical Neurology, 2013
- Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug AdministrationBMJ, 2012
- Clinical research with transcranial direct current stimulation (tDCS): Challenges and future directionsBrain Stimulation, 2011
- Stability selectionJournal of the Royal Statistical Society Series B: Statistical Methodology, 2009
- Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and researchClinical Neurophysiology, 2009
- Trajectories of change in depression severity during treatment with antidepressantsPsychological Medicine, 2009
- An analysis of functional neuroimaging studies of dorsolateral prefrontal cortical activity in depressionPsychiatry Research: Neuroimaging, 2006
- Regularization and Variable Selection Via the Elastic NetJournal of the Royal Statistical Society Series B: Statistical Methodology, 2005
- Estimation of linear mixed models with a mixture of distribution for the random effectsComputer Methods and Programs in Biomedicine, 2005
- Inflation of R 2 in Best Subset RegressionTechnometrics, 1980