Electrical and Magnetic Stimulation of the Brain; Are These Methods Used Appropriately in Treating Depression? Part 2. Where should Transcranial Direct Current Stimulation be Placed in an Algorithm for the Treatment of Resistant Depression?

ABSTRACT

Depression is a common condition which causes serious of morbidity among the population. While treatment is often provided with pharmacological antidepressants and psychotherapy, many patients do not respond to such treatment, and therefore algorithms have been proposed to develop treatments for resistant depression. Transcranial Direct Current Stimulation is a relatively new form of treatment for depression, which appear to have a good safety profile and appear to be acceptable to patients. Other forms of Brain Stimulation, such as Electro-Convulsive therapy, have a more complex safety profile, and require anaesthesia. Still other forms of electrical stimulation of the brain, such as Vagus nerve Stimulation are invasive in nature. The position of a particular modality of treatment in the Algorithm for the treatment of Resistant Depression depends on a balance between effectiveness of treatment, side effect profile, acceptability to the patients, availability of treatment, invasiveness of treatment, and the possibility of combining it with other treatments. Here we assess the position of Transcranial Direct Current Stimulation in such an Algorithm for the treatment of Resistant Depression. Given its effectiveness and its relatively good side effect profile, we suggest that it could be used early in the treatment of depression, however its use may be limited by lack of necessary equipment. On the other hand, Electro-convulsive therapy must be reserved for much more resistant cases, because of the need for anaesthesia and muscle relaxants, as well as its side effect profile, even though it might be somewhat more effective than the other modalities. Further study of Transcranial Direct Current Stimulation is warranted.