Transcranial direct current stimulation (tDCS) for depression in pregnancy: A pilot randomized controlled trial

Abstract

BACKGROUND\nDepression in pregnancy negatively affects maternal-child health. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation treatment for depression, has not been evaluated in pregnancy.\n\n\nOBJECTIVE\nTo conduct a pilot randomized controlled trial (RCT) to evaluate tDCS for antenatal depression.\n\n\nMETHODS\nIn this pilot RCT in Toronto, Ontario (October 2014 to December 2016), adult pregnant women 14-32 weeks gestation with major depressive disorder who had declined antidepressant medication were considered for inclusion. Participants were randomly assigned 1:1 to tDCS or sham-control. Active tDCS comprised 30-min sessions of 2 mAmp direct current delivered over the dorsolateral prefrontal cortex, 5 days per week, for 3 weeks. Sham was administered similarly, but with current turned off after 30\u202fs. Main outcomes were feasibility, acceptability, and protocol adherence. Maternal Montgomery Asperg Depression Rating Scale (MADRS) was measured post-treatment and at 4 and 12 weeks postpartum.\n\n\nRESULTS\nOf 20 women randomized, 16 completed treatment and provided data (124 tDCS, 122 sham sessions). Views of treatment were positive with no serious adverse events. Post-treatment estimated marginal mean MADRS scores were 11.8 (standard error, SE 2.66) for tDCS and 15.4 (SE 2.51) for sham (p\u202f=\u202f0.34). At 4 weeks postpartum, 75.0% of tDCS women were remitted versus 12.5% sham-control (p\u202f=\u202f0.04).\n\n\nCONCLUSIONS\nResults support proceeding to a definitive RCT to evaluate tDCS for antenatal depression. The preliminary efficacy estimates immediately post-treatment and in the postpartum, are encouraging with respect to the potential use of tDCS to improve treatment rates in this population. The trial was registered at: clinical trials.gov (NCT02116127).