Study Objectives: Stroke is a major neurological disease significantly threatening the human health and life with a high morbidity, disability, and mortality. Post-stroke depression (PSD) is one of the common complications of stroke. PSD has been a major factor hindering the recovery of neurological functions and daily activities in stroke patients and is closely related to the social avoidance and increased mortality of stroke patients. Although antidepressant drug treatment has improved during the last decades, symptoms in about 20% of the patients are not in remission two years after initiation of pharmacological intervention. Nowadays, non-invasive brain stimulation; techniques; transcranial direct current stimulation (tCDS) has gained an important interest in the treatment of many neuropsychiatric disorders which might be of some help in treatment of PSD. The goal of the current study is to evaluate the beneficial short term role of tDCS on post-stroke depression. Study Design: This was a randomized double blind placebo-controlled clinical trial included forty hemiparetic patients with post-stroke depression from outpatient clinic of Faculty of Physical Therapy, Cairo University, in the period between June 2018 to June 2019. All patients diagnosed as having a PSD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Depression was evaluated by Hamilton Depression Rating Scale (HAM-D) pre and post treatment and quality of life was evaluated by the Stroke Specific Quality Of Life scale (SS-QOL). Patients were assigned randomly into two groups: the study group A and the control group B. Both groups received antidepressant medication in addition to physical therapy program. Group A received tCDS for 30 minutes, three times per week for one month, while the group B received sham transcranial direct current stimulation. Results: Active tDCS was significantly superior to sham with significant improvement in depression and Stroke Specific Quality Of Life in treated group in comparison to group B, p = 0.000. Conclusion: tDCS was effective for post- stroke depression and might be a favorable option for treating post-stroke patients.
KeywordsPost-Stroke DepressionTranscranial Direct Current StimulationDiagnostic and Statistical Manual of Mental Disorders
Benjamin, E.J., Blaha, M.J., Chiuve, S.E., Cushman, M., Das, S.R., Deo, R., de Ferranti, S.D., Floyd, J., Fornage, M., Gillespie, C. and Isasi, C.R. (2017) Heart Disease and Stroke Statistics—2017 Update: A Report from the American Heart Association. Circulation, 135, e146-e603. https://doi.org/10.1161/CIR.0000000000000485
Hadidi, N., Treat-Jacobson, D.J. and Lindquist, R. (2009) Poststroke Depression and Functional Outcome: A Critical Review of Literature. Heart Lung, 38, 151-162. https://doi.org/10.1016/j.hrtlng.2008.05.002
Mohammed, G.F., Azab, H.M., Sayed, M.A., Elnady, H.M., Youssif, H. and Mahmoud, O.A. (2019) Risk Factors for Post-Stroke Depression in Sohag University Hospital. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 55, 11. https://doi.org/10.1186/s41983-019-0057-z
Jorge, R.E., Robinson, R.G., Tateno, A., et al. (2004) Repetitive Transcranial Magnetic Stimulation as Treatment of Post Stroke Depression: A Preliminary Study. Biological Psychiatry, 55, 398-405. https://doi.org/10.1016/j.biopsych.2003.08.017
Van Asseldonk, E.H. and Boonstra, T.A. (2016) Transcranial Direct Current Stimulation of the Leg Motor Cortex Enhances Coordinated Motor Output during Walking with a Large Inter-Individual Variability. Brain Stimulation, 9, 182-190. https://doi.org/10.1016/j.brs.2015.10.001
Miniussi, C. (2016) A Foreword on the Use of Noninvasive Brain Stimulation in Psychology. European Psychologist, 21, 1-3. https://doi.org/10.1027/1016-9040/a000253
Nitsche, M.A., Cohen, L.G., Wassermann, E.M., Priori, A., Lang, N., Antal, A. and Pascual-Leone, A. (2008) Transcranial Direct Current Stimulation: State of the Art. Brain Stimulation, 1, 206-223. https://doi.org/10.1016/j.brs.2008.06.004
Stagg, C.J. and Nitsche, M.A. (2011) Physiological Basis of Transcranial Direct Current Stimulation. The Neuroscientist, 17, 37-53. https://doi.org/10.1177/1073858410386614
Martin, D.M., Moffa, A., Nikolin, S., Bennabi, D., Brunoni, A.R., Flannery, W., et al. (2018) Cognitive Effects of Transcranial Direct Current Stimulation Treatment in Patients with Major Depressive Disorder: An Individual Patient Data Meta-Analysis of Randomized, Sham-Controlled Trials. Neuroscience and Biobehavioral Reviews, 90, 137-145. https://doi.org/10.1016/j.neubiorev.2018.04.008
Moffa, A.H., Brunoni, A.R., Fregni, F., Palm, U., Padberg, F., Blumberger, D.M., et al. (2017) Safety and Acceptability of Transcranial Direct Current Stimulation for the Acute Treatment of Major Depressive Episodes: Analysis of Individual Patient Data. Journal of Affective Disorders, 221, 1-5. https://doi.org/10.1016/j.jad.2017.06.021
Grajny, K., Pyata, H., Spiegel, K., Lacey, E.H., Xing, S., Brophy, C. and Turkeltaub, P.E. (2016) Depression Symptoms in Chronic Left Hemisphere Stroke Are Related to Dorsolateral Prefrontal Cortex Damage. The Journal of Neuropsychiatry and Clinical Neurosciences, 28, 292-298. https://doi.org/10.1176/appi.neuropsych.16010004
Hosseinzadeh, S.A., Mazhari, S., Najafi, K., Ahmadi, M., Aghaei, I. and Khaksarian, M. (2018) Anodal Transcranial Direct Current Stimulation Enhances Positive Changes in Movement Functions, Visual Attention and Depression of Patients with Chronic Ischemic Stroke: A Clinical Trail. Biomedical Research and Therapy, 5, 2841-2849. https://doi.org/10.15419/bmrat.v5i11.503
Fregni, F., Boggio, P.S., Nitsche, M.A., Marcolin, M.A., Rigonatti, S.P. and Pascual-Leone, A. (2006) Treatment of Major Depression with Transcranial Direct Current Stimulation. Bipolar Disorder, 8, 203-204. https://doi.org/10.1111/j.1399-5618.2006.00291.x
Rigonatti, S.P., Boggio, P.S., Myczkowski, M.L., Otta, E., Fiquer, J.T., Ribeiro, R.B., Nitsche, M.A., Pascual-Leone, A. and Fregni, F. (2008) Transcranial Direct Stimulation and Fluoxetine for the Treatment of Depression. European Psychiatry, 23, 74-76. https://doi.org/10.1016/j.eurpsy.2007.09.006
Valiengo, L.C.L., Goulart, A.C., de Oliveira, J.F., Benseñor, I.M., Lotufo, P.A. and Brunoni, A.R. (2017) Transcranial Direct Current Stimulation for the Treatment of Post-Stroke Depression: Results from a Randomised, Sham-Controlled, Double-Blinded Trial. Journal of Neurology, Neurosurgery, and Psychiatry, 88, 170-175. https://doi.org/10.1136/jnnp-2016-314075
Brunoni, A.R., Nitsche, M.A., Bolognini, N., Bikson, M., Wagner, T., Merabet, L. and Ferrucci, R. (2012) Clinical Research with Transcranial Direct Current Stimulation (tDCS): Challenges and Future Directions. Brain Stimulation, 5, 175-195. https://doi.org/10.1016/j.brs.2011.03.002
Hatano, S. (1976) Experience from a Multicentre Stroke Register: A Preliminary Report. Bulletin of the World Health Organization, 54, 541-553.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th Edition, American Psychiatric Press, Inc., Washington DC. https://doi.org/10.1176/appi.books.9780890425596
Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-Mental State”: A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198. https://doi.org/10.1016/0022-3956(75)90026-6
Rossi, S., Hallett, M., Rossini, P.M. and Pascual-Leone, A. (2009) Safety, Ethical Considerations, and Application Guidelines for the Use of Transcranial Magnetic Stimulation in Clinical Practice and Research. Clinical Neurophysiology, 120, 2008-2039. https://doi.org/10.1016/j.clinph.2009.08.016
Bueno, V.F., Brunoni, A.R., Boggio, P.S., et al. (2011) Mood and Cognitive Effects of Transcranial Direct Current Stimulation in Post-Stroke Depression. Neurocase, 17, 318-322. https://doi.org/10.1080/13554794.2010.509319
Hamilton, M. (1960) A Rating Scale for Depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56-62. https://doi.org/10.1136/jnnp.23.1.56
Williams, L.S., Weinberger, M., Harris, L.E., Clark, D.O. and Biller, J. (1999) Development of a Stroke-Specific Quality of Life Scale. Stroke, 30, 1362-1369. https://doi.org/10.1161/01.STR.30.7.1362
Duan, X., Yao, G., Liu, Z., Cui, R. and Yang, W. (2018) Mechanisms of Transcranial Magnetic Stimulation Treating on Post-Stroke Depression. Frontiers in Human Neuroscience, 12, 215. https://doi.org/10.3389/fnhum.2018.00215
Herrera-Melendez, A., Bajbouj, M. and Aust, S. (2019) Application of Transcranial Direct Current Stimulation in Psychiatry. Neuropsychobiology, 1-12. https://doi.org/10.1159/000501227
Valiengo, L., Casati, R., Bolognini, N., Lotufo, P.A., Benseñor, I.M., Goulart, A.C. and Brunoni, A.R. (2016) Transcranial Direct Current Stimulation for the Treatment of Post-Stroke Depression in Aphasic Patients: A Case Series. Neurocase, 22, 225-228. https://doi.org/10.1080/13554794.2015.1130231
Grimm, S., Beck, J., Schuepbach, D., Hell, D., Boesiger, P., Bermpohl, F., et al. (2008) Imbalance between Left and Right Dorsolateral Prefrontal Cortex in Major Depression Is Linked to Negative Emotional Judgment: An fMRI Study in Severe Major Depressive Disorder. Biological Psychiatry, 63, 369-376. https://doi.org/10.1016/j.biopsych.2007.05.033
Moliadze, V., Antal, A. and Paulus, W. (2010) Electrode-Distance Dependent After-Effects of Transcranial Direct and Random Noise Stimulation with Extracephalic Reference Electrodes. Clinical Neurophysiology, 121, 2165-2171. https://doi.org/10.1016/j.clinph.2010.04.033
Viana, R.T., Laurentino, G.E., Souza, R.J., et al. (2014) Effects of the Addition of Transcranial Direct Current Stimulation to Virtual Reality Therapy after Stroke: A Pilot Randomized Controlled Trial. NeuroRehabilitation, 34, 437-446. https://doi.org/10.3233/NRE-141065
Elsner, B., Kwakkel, G., Kugler, J. and Mehrholz, J. (2017) Transcranial Direct Current Stimulation (tDCS) for Improving Capacity in Activities and Arm Function after Stroke: A Network Meta-Analysis of Randomized Controlled Trials. Journal of NeuroEngineering and Rehabilitation, 14, 95. https://doi.org/10.1186/s12984-017-0301-7
Elsner, B., Kugler, J. and Mehrholz, J. (2018) Transcranial Direct Current Stimulation (tDCS) for Upper Limb Rehabilitation after Stroke: Future Directions. Journal of NeuroEngineering and Rehabilitation, 15, 106. https://doi.org/10.1186/s12984-018-0459-7
Schjetnan, A.G., Faraji, J., Metz, G.A., Tatsuno, M. and Luczak, A. (2013) Transcranial Direct Current Stimulation in Stroke Rehabilitation: A Review of Recent Advancements. Stroke Research and Treatment, 2013, Article ID: 170256. https://doi.org/10.1155/2013/170256
Fregni, F., Boggio, P., Nitsche, M. and Rigonatti, S. (2006) Cognitive Effects of Repeated Sessions of Transcranial Direct Current Stimulation in Patients with Depression. Depression and Anxiety, 23, 482-484. https://doi.org/10.1002/da.20201
Pisoni, A., Mattavelli, G., Papagno, C., Rosanova, M., Cacali, A. and Lauro, L. (2018) Cognitive Enhancement Induced by Anodal tDCS Drives Circuit-Specific Cortical Plasticity. Cerebral Cortex, 28, 1132-1140. https://doi.org/10.1093/cercor/bhx021