经颅直流电刺激
萧条(经济学)
双相情感障碍
神经可塑性
神经科学
抗抑郁药
心理学
脑刺激
系统回顾
随机对照试验
医学
刺激
精神科
临床心理学
焦虑
物理医学与康复
梅德林
认知
内科学
政治学
法学
经济
宏观经济学
作者
Giordano D’Urso,Elena Toscano,Annarita Barone,Mario Palermo,Bernardo Dell’Osso,Giorgio Di Lorenzo,Antonio Mantovani,Giovanni Martinotti,Michele Fornaro,Felice Iasevoli,Andrea de Bartolomeis
标识
DOI:10.1016/j.pnpbp.2022.110672
摘要
Despite multiple available treatments for bipolar depression (BD), many patients face sub-optimal responses. Transcranial direct current stimulation (tDCS) has been advocated in the management of different conditions, including BD, especially in treatment-resistant cases. The optimal dose and timing of tDCS, the mutual influence with other concurrently administered interventions, long-term efficacy, overall safety, and biological underpinnings nonetheless deserve additional assessment. The present study appraised the existing clinical evidence about tDCS for bipolar depression, delving into the putative biological underpinnings with a special emphasis on cellular and molecular levels, with the ultimate goal of providing a translational perspective on the matter. Two separate systematic reviews across the PubMed database since inception up to August 8th 2022 were performed, with fourteen clinical and nineteen neurobiological eligible studies. The included clinical studies encompass 207 bipolar depression patients overall and consistently document the efficacy of tDCS, with a reduction in depression scores after treatment ranging from 18% to 92%. The RCT with the largest sample clearly showed a significant superiority of active stimulation over sham. Mild-to-moderate and transient adverse effects are attributed to tDCS across these studies. The review of neurobiological literature indicates that several molecular mechanisms may account for the antidepressant effect of tDCS in BD patients, including the action on calcium homeostasis in glial cells, the enhancement of LTP, the regulation of neurotrophic factors and inflammatory mediators, and the modulation of the expression of plasticity-related genes. To the best of our knowledge, this is the first study on the matter to concurrently provide a synthesis of the clinical evidence and an in-depth appraisal of the putative biological underpinnings, providing consistent support for the efficacy, safety, and tolerability of tDCS.
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