Transcranial direct current stimulation (tDCS) in the treatment of depression: Systematic review and meta-analysis of efficacy and tolerability

Abstract

Background: Transcranial direct current stimulation (tDCS) is a potential alternative treatment option for major depressive episodes (MDE).

Objectives: We address the efficacy and safety of tDCS in MDE.

Methods: The outcome measures were Hedges' g for continuous depression ratings, and categorical response and remission rates.

Results: A random effects model indicated that tDCS was superior to sham tDCS (k=11, N=393, g=0.30, 95% CI=[0.04, 0.57], p=0.027). Adjunctive antidepressant medication and cognitive control training negatively impacted on the treatment effect. The pooled log odds ratios (LOR) for response and remission were positive, but statistically non-significant (response: k=9, LOR=0.36, 95% CI[-0.16, 0.88], p=0.176, remission: k=9, LOR=0.25, 95% CI [-0.42, 0.91], p=0.468). We estimated that for a study to detect the pooled continuous effect (g=0.30) at 80% power (alpha=0.05), a total N of at least 346 would be required (with the total N required to detect the upper and lower bound being 49 and 12,693, respectively).

Conclusions: tDCS may be efficacious for treatment of MDE. The data do not support the use of tDCS in treatment-resistant depression, or as an add-on augmentation treatment. Larger studies over longer treatment periods are needed.

Keywords: Cognitive control training; Depression; Meta-analysis; Non-pharmacological therapies; Remission; Response; Systematic review; Transcranial direct current stimulation; tDCS.