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Association between tDCS computational modeling and clinical outcomes in depression: data from the ELECT-TDCS trial

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Abstract

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation intervention investigated for the treatment of depression. Clinical results have been heterogeneous, partly due to the variability of electric field (EF) strength in the brain owing to interindividual differences in head anatomy. Therefore, we investigated whether EF strength was correlated with behavioral changes in 16 depressed patients using simulated electric fields in real patient data from a controlled clinical trial. We hypothesized that EF strength in the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), brain regions implicated in depression pathophysiology, would be associated with changes in depression, mood and anxiety scores. SimNIBS were used to simulate individual electric fields based on the MRI structural T1-weighted brain scans of depressed subjects. Linear regression models showed, at the end of the acute treatment phase, that simulated EF strength was inversely associated with negative affect in the bilateral ACC (left: β = − 160.463, CI [− 291.541, − 29.385], p = 0.021; right: β = − 189.194, CI [− 289.479, − 88.910], p = 0.001) and DLPFC (left: β = − 93.210, CI [− 154.960, − 31.461], p = 0.006; right: β = − 82.564, CI [− 142.867, − 22.262], p = 0.011) and with depression scores in the left ACC (β = − 156.91, CI [− 298.51, − 15.30], p = 0.033). No association between positive affect or anxiety scores, and simulated EF strength in the investigated brain regions was found. To conclude, our findings show preliminary evidence that EF strength simulations might be associated with further behavioral changes in depressed patients, unveiling a potential mechanism of action for tDCS. Further studies should investigate whether individualization of EF strength in key brain regions impact clinical response.

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Funding

ELECT-TDCS funding: São Paulo Research State Foundation (FAPESP): grants FAPESP 2012/20911-5 and 2018/21722-8.

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Authors and Affiliations

  1. Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Paulo J. C. Suen & Marcelo C. Batistuzzo

  2. Department of Psychology, University of Münster, Münster, Germany

    Sarah Doll

  3. Center for Interdisciplinary Research on Applied Neurosciences (NAPNA) and Laboratory of Psychiatric Neuroimaging, Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil

    Geraldo Busatto

  4. Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, Service of Interdisciplinary Neuromodulation, Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Instituto de Psiquiatria, R Dr Ovidio Pires de Campos 785, 2o andar, Ala Sul, São Paulo, CEP, 05403-000, Brazil

    Lais B. Razza & Andre R. Brunoni

  5. Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

    Zhi-De Deng

  6. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA

    Zhi-De Deng

  7. Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany

    Frank Padberg, Eva Mezger, Lucia Bulubas & Daniel Keeser

  8. International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany

    Lucia Bulubas

  9. Department of Clinical Radiology, University Hospital, LMU Munich, Munich, Germany

    Daniel Keeser

  10. Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo and Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, São Paulo, 05508-000, Brazil

    Andre R. Brunoni

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  1. Paulo J. C. Suen
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  2. Sarah Doll
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Correspondence to Andre R. Brunoni.

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Suen, P.J.C., Doll, S., Batistuzzo, M.C. et al. Association between tDCS computational modeling and clinical outcomes in depression: data from the ELECT-TDCS trial. Eur Arch Psychiatry Clin Neurosci 271, 101–110 (2021). https://doi.org/10.1007/s00406-020-01127-w

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