SSRI vs tDCS for Depression: Which is Better?

HealthDay News — Escitalopram may outperform transcranial direct-current stimulation (tDCS) in the treatment of major depressive disorder, according to a study published in the New England Journal of Medicine.

Andre Brunoni, MD, PhD, director of the Service of Interdisciplinary Neuromodulation at the University of Sao Paulo in Brazil, and colleagues randomly assigned 245 patients with depression to 1 of 4 groups. One group had tDCS plus a placebo pill, another had sham tDCS plus escitalopram. The third group had tDCS plus escitalopram, and the final group had sham tDCS plus a placebo. The treatment was given for 15 consecutive days at 30 minutes each, then once a week for 7 weeks. Escitalopram was taken daily for 3 weeks, after which the daily dose was increased from 10 to 20 mg for the next 7 weeks.

After 10 weeks, patients receiving tDCS fared no better than those taking escitalopram. Patients receiving tDCS, however, experienced more side effects, the researchers found. Specifically, patients receiving tDCS had higher rates of skin redness, ringing in the ears, and nervousness than those receiving sham brain stimulation. In addition, 2 patients receiving tDCS developed new cases of mania. Patients taking escitalopram reported more frequent sleepiness and constipation.

“tDCS has been increasingly used as an off-label treatment by physicians,” Dr Brunoni told HealthDay. “Our study revealed that it cannot be recommended as a first-line therapy yet and should be investigated further.”

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Brunoni AR, Moffa AH, Sampaio-Junior B, et al. Trial of electrical direct-current therapy versus escitalopram for depression [published online June 29, 2017]. N Engl J Med. doi:10.1056/NEJMoa1612999