Transcranial Direct Current Stimulation in Psychiatric Disorders
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City University of New York (CUNY) CUNY Academic Works Publications and Research City College of New York 2015 Transcranial direct current stimulation in psychiatric disorders Gabriel Tortella University of São Paulo Roberta Casati Università degli Studi Milano Bicocca Luana V M Aparicio University of São Paulo Antonio Mantovani CUNY City College Natasha Senço University of São Paulo See next page for additional authors How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/cc_pubs/658 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] Authors Gabriel Tortella, Roberta Casati, Luana V M Aparicio, Antonio Mantovani, Natasha Senço, Giordano D'Urso, Jerome Brunelin, Fabiana Guarienti, Priscila Mara Lorencini Selingardi, Débora Muszkat, Bernardo de Sampaio Pereira Junior, Leandro Valiengo, Adriano H. Moffa, Marcel Simis, Lucas Borrione, and Andre R. Brunoni This article is available at CUNY Academic Works: https://academicworks.cuny.edu/cc_pubs/658 World Journal of W J P Psychiatry Submit a Manuscript: http://www.wjgnet.com/esps/ World J Psychiatr 2015 March 22; 5(1): 88-102 Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx ISSN 2220-3206 (online) DOI: 10.5498/wjp.v5.i1.88 © 2015 Baishideng Publishing Group Inc. All rights reserved. REVIEW Transcranial direct current stimulation in psychiatric disorders Gabriel Tortella, Roberta Casati, Luana V M Aparicio, Antonio Mantovani, Natasha Senço, Giordano D’Urso, Jerome Brunelin, Fabiana Guarienti, Priscila Mara Lorencini Selingardi, Débora Muszkat, Bernardo de Sampaio Pereira Junior, Leandro Valiengo, Adriano H Moffa, Marcel Simis, Lucas Borrione, André R Brunoni Gabriel Tortella, Natasha Senço, Fabiana Guarienti, Priscila Commons Attribution Non Commercial (CC BY-NC 4.0) license, Mara Lorencini Selingardi, Débora Muszkat , Bernardo de which permits others to distribute, remix, adapt, build upon this Sampaio Pereira Junior, Leandro Valiengo, André R Brunoni, work non-commercially, and license their derivative works on Service of Interdisciplinary Neuromodulation, Laboratory of different terms, provided the original work is properly cited and Neurosciences (LIM-27), Department and Institute of Psychiatry, the use is non-commercial. See: http://creativecommons.org/ University of São Paulo, São Paulo 05043-000, Brazil licenses/by-nc/4.0/ Gabriel Tortella, Luana V M Aparicio, Fabiana Guarienti, Correspondence to: Gabriel Tortella, PSC, Service of Interdis- Bernardo de Sampaio Pereira Junior, Leandro Valiengo, Adriano ciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), H Moffa, Lucas Borrione, André R Brunoni, Interdisciplinary Center Department and Institute of Psychiatry, University of São Paulo, R. for Applied Neuromodulation, University Hospital, University of Dr. Ovidio Pires de Campos, 785, 2nd floor, Instituto de Psiquiatria - São Paulo, São Paulo 05508-000, Brazil HCFMUSP, São Paulo 05043-000, Roberta Casati, Psychology Department, Advanced School in Brazil. [email protected] Neuropsychology, Università degli Studi Milano Bicocca, 20126 Telephone: +55-11-26618159 Milano, Italy Fax: +55-11-26618159 Antonio Mantovani, Department of Physiology, Pharmacology Received: September 26, 2014 and Neuroscience Sophie Davis School of Biomedical Education Peer-review started: September 27, 2014 City University of New York (CUNY), New York, NY 10031, First decision: November 19, 2014 United States Revised: December 12, 2014 Natasha Senço, Obsessive Compulsive Disorder Project Accepted: December 29, 2014 (PROTOC), Department and Institute of Psychiatry, University of Article in press: December 31, 2014 São Paulo, São Paulo 01060-970, Brazil Published online: March 22, 2015 Giordano D’Urso, Unit of Psychiatry Department of Neurosciences, Reproductive and Odontostomatological Sciences University of Naples Federico II, 80131 Napoli, Italy Jerome Brunelin, Université de Lyon, Université Claude Bernard Abstract Lyon I, Centre Hospitalier le Vinatier, 69100 Villeurbanne, France Débora Muszkat, National Institute of Developmental Psychiatry The interest in non-invasive brain stimulation techniques for Children and Adolescents (INCT-CNPq), Department of is increasing in recent years. Among these techniques, Psychiatry Department and Institute of Psychiatry, University of transcranial direct current stimulation (tDCS) has been São Paulo, São Paulo 04101300, Brazil the subject of great interest among researchers because Marcel Simis, Santa Casa de São Paulo Medical School, São of its easiness to use, low cost, benign profile of side Paulo 01307-002, Brazil effects and encouraging results of research in the Marcel Simis, Institute of Physical Medicine and Rehabilitation, field. This interest has generated several studies and Clinics Hospital of the University of Sao Paulo Medical School, randomized clinical trials, particularly in psychiatry. In São Paulo 01307-002, Brazil Author contributions: All authors contributed to this manuscript. this review, we provide a summary of the development Conflict-of-interest: The authors declare that there is no conflict of the technique and its mechanism of action as well as of interests regarding the publication of this article. a review of the methodological aspects of randomized Open-Access: This article is an open-access article which was clinical trials in psychiatry, including studies in affective selected by an in-house editor and fully peer-reviewed by external disorders, schizophrenia, obsessive compulsive disorder, reviewers. It is distributed in accordance with the Creative child psychiatry and substance use disorder. Finally, WJP|www.wjgnet.com 88 March 22, 2015|Volume 5|Issue 1| Tortella G et al . Transcranial direct current stimulation in psychiatric disorders we provide an overview of tDCS use in cognitive stimulation for the treatment of depressive or manic enhancement as well as a discussion regarding its symptoms[2]. The interest on “brain polarization” (as clinical use and regulatory and ethical issues. Although transcranial DC stimulation was described at that time) many promising results regarding tDCS efficacy were declined during the 2nd half of the last century, with the described, the total number of studies is still low, social stigma related to electroconvulsotherapy and highlighting the need of further studies aiming to the “golden age” of psychopharmacology. Only in the replicate these findings in larger samples as to provide a last 15 years, the findings that weak, DC stimulation definite picture regarding tDCS efficacy in psychiatry. delivered transcranially (tDCS) could induce prolonged neuroplastic changes in cortical excitability[4,5] with Key words: Non-invasive brain stimulation; Transcranial functional effects in healthy subjects[6], contributed to direct current stimulation; Psychiatry disorders; Review a resurgence of the interest in this technique not only as research tool but also as a potential approach for © The Author(s) 2015. Published by Baishideng Publishing the treatment of several psychiatric disorders, such Group Inc. All rights reserved. major depressive disorder, schizophrenia, obsessive- compulsive disorder and also other psychiatric and Core tip: Transcranial direct current stimulation (tDCS) [7-11] has been the subject of great interest among researchers neurological disorders . because of its easiness to use, low cost, benign profile of side effects and encouraging results of research in Technical aspects and mechanisms of action of tDCS the field. In this review, we provide a summary of the tDCS is described as a non-invasive form of brain development of the technique and its mechanism of stimulation that uses a low-intensity, constant current action as well as a review of the methodological aspects applied directly to the head through scalp electrodes[12]. of randomized clinical trials in psychiatry and we provide This form of brain stimulation can induce significant an overview of tDCS use in cognitive enhancement currents in superficial cortical areas (see The stimulated as well as a discussion regarding its clinical use and brain, Elsevier 2014, Chapter 2, for a review and further regulatory and ethical issues. references) and, since the current used is sub threshold, it can modulate neuronal excitability without triggering action potentials[13], by facilitation or inhibition of Tortella G, Casati R, Aparicio LM, Mantovani A, Senço N, D’ spontaneous neural activity according to the polarity of Urso G, Brunelin J, Guarienti F, Selingardi PML, Muszkat the electrodes[14]. Generally, anodal stimulation induces D, Junior BSP, Valiengo L, Moffa AH, Simis M, Borrione L, an increase of cortical excitability, whereas cathodal Brunoni AR. Transcranial direct current stimulation in psychiatric stimulation decreases cortical excitability, effects that disorders. World J Psychiatr 2015; 5(1): 88-102 Available from: may last beyond the stimulation period[4,5], up to 30-120 URL: http://www.wjgnet.com/2220-3206/full/v5/i1/88.htm DOI: [15] min . In fact, the polarity-dependent effects are more http://dx.doi.org/10.5498/wjp.v5.i1.88 complex and also dependent of the spatial organization of the cells: inward current flow at the cortex (anodal tDCS) generates hyperpolarization of apical dendritic regions of pyramidal cortical neurons and depolarization INTRODUCTION of somatic regions, whereas outward current flow The interest