CoChat
Sign Up
Cited by 455Transcranial Magnetic Stimulation StudiesElectroconvulsive Therapy StudiesTreatment of Major Depression

Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial

Open access
Loo, Colleen K., Alonzo, Angelo, Martin, Donel, Mitchell, Philip B., Galvez, Veronica, Sachdev, Perminder·2012·British Journal of Psychiatry
DOI 10.1192/bjp.bp.111.097634
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Preliminary evidence suggests transcranial direct current stimulation (tDCS) has antidepressant efficacy. Aims: To further investigate the efficacy of tDCS in a double-blind, sham-controlled trial (registered at www.clinicaltrials.gov: NCT00763230). Method: Sixty-four participants with current depression received active or sham anodal tDCS to the left prefrontal cortex (2 mA, 15 sessions over 3 weeks), followed by a 3-week open-label active treatment phase. Mood and neuropsychological effects were assessed. Results: There was significantly greater improvement in mood after active than after sham treatment (P<0.05), although no difference in responder rates (13% in both groups). Attention and working memory improved after a single session of active but not sham tDCS (P<0.05). There was no decline in neuropsychological functioning after 3–6 weeks of active stimulation. One participant with bipolar disorder became hypomanic after active tDCS. Conclusions: Findings confirm earlier reports of the antidepressant efficacy and safety of tDCS. Vigilance for mood switching is advised when administering tDCS to individuals with bipolar disorder.

AI snapshot

Written from the paper’s full text.

TL;DR

In this 3-week randomised sham-controlled trial, active anodal tDCS to the left dorsolateral prefrontal cortex produced significantly greater MADRS improvement than sham in 64 depressed outpatients, but responder rates did not differ and effects were clinically modest. tDCS was cognitively safe, with acute attention/working-memory improvement after one active session and one hypomanic switch in a participant with bipolar disorder.

Key findings

  • Active tDCS showed significantly greater improvement in mood than sham over the 3-week sham-controlled phase on the primary MADRS outcome (P<0.05; effect size 0.49), but there was no difference in responder rates (13% in both groups; 4 responders in each group).
  • Over the sham-controlled phase, the only significant group main effect was on QIDS-SR, with higher scores in the sham group; other mood scales did not show significant group×time interactions, and QIDS-C only trended toward significance.
  • Attention and working memory improved immediately after a single active tDCS session on the SDMT (P<0.05), but not after sham; no decline in neuropsychological functioning was found after 3–6 weeks of active stimulation.
  • The NNT was 16.7 for the 3-week active-vs-sham comparison and 2.6 for 6 weeks of active tDCS compared with 3 weeks of sham; one participant with bipolar disorder became hypomanic after active tDCS.

Methods

  • Double-blind, sham-controlled randomised trial in 64 outpatients with a DSM-IV major depressive episode and baseline MADRS ≥20; participants were stratified by gender and age and assigned to active (n=33) or sham (n=31) treatment.
  • Active or sham anodal tDCS was given to the left dorsolateral prefrontal cortex (F3) with the cathode over the contralateral orbit (F8): 2 mA for 20 min, every weekday for 15 sessions over 3 weeks, followed by a 3-week open-label active phase; sham used 1 mA for 30 s.
  • Primary mood outcome was MADRS, with additional mood ratings (IDS, CGI-S, QIDS-C, QIDS-SR) and a neuropsychological battery; analyses used intention-to-treat last-observation-carried-forward scores and mixed between-within ANCOVA covarying for baseline CORE scores.

Limitations

  • The paper states that most participants continued antidepressant medications concurrently with tDCS, so the effects of tDCS could not be assessed independently of medications, and this may have limited further antidepressant effects.
  • The paper states that the second 3 weeks were open-label, limiting interpretation of the 6-week outcomes and making it impossible to determine whether benefit was related to the number of treatments or the overall treatment duration.
  • Evident from the text: the sham-controlled phase had 58 completers, responder analyses were based on small numbers, and no participants in either group met remission criteria (MADRS ≤10) during that phase.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1192/bjp.bp.111.097634

Cites

33 of 33 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 31 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Mood outcomes

    The only main effect of group was found in the QIDS-SR with higher scores for the sham group.

    “The only main effect of group was found in the QIDS-SR with higher scores for the sham group.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Mood outcomes

    By the end of the additional open-label phase, 15 participants in the active group and 12 participants in the sham group met the criterion for response.

    “By the end of the additional open-label phase, 15 participants in the active group and 12 participants in the sham group met the criterion for response.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Mood outcomes

    At 1-week follow-up the proportion of responders was 16/26 (active group) and 6/26 (sham group).

    “At 1-week follow-up the proportion of responders was 16/26 (active group) and 6/26 (sham group).”
    Quote in the paperSubstantial claim
  • Findingown data
    § Mood outcomes

    At 1-month follow-up there were 13/20 (active group) and 7/23 (sham group) responders.

    “At 1-month follow-up there were 13/20 (active group) and 7/23 (sham group) responders.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Mood outcomes

    There were significant main effects of time over the sham-controlled phase for all mood outcome measures, indicating that scores were significantly lower at the end of the sham-controlled phase compared with baseline.

    “There were significant main effects of time over the shamcontrolled phase for all mood outcome measures indicating that scores were significantly lower at the end of the sham-controlled phase compared with baseline (Table 2).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 28
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 16

  • May combine two claims. The quote only partly states this claim.

    Findingown data
    § Neuropsychological functioningsham v. active tDCS

    Analyses of participants' performance in the SDMT immediately before and after the first and final sessions in the sham-controlled phase showed a significant effect of time only at the first tDCS session, and a significant interaction between time and group with simple effects revealing no difference between pre- and post-tDCS scores for the sham group, whereas scores in the active group improved.

    “group, whereas scores in the active group significantly improved following tDCS (Table 4).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Effects of 6 weeks of active tDCS on neuropsychological test performance

    In the active group (the only group to receive 6 weeks of active tDCS), there was a trend for main effect of time on the Letter-Number Sequencing Task, suggesting higher scores at 6 weeks compared with baseline (F=3.46, d.f.=28, P=0.07), and no significant differences over time were found within the other measures: RAVLT total, RAVLT delay, Digit Span Forwards, Digit Span Backwards, Stroop Interfe

    “In the active group (the only group to receive 6 weeks of active tDCS), there was a trend for main effect of time on the Letter-Number Sequencing Task, suggesting higher scores at 6 weeks compared with baseline (F = 3.46, d.f.= 28, P = 0.07).No significant differences over time were found within the other measures: RAVLT total (F = 0.12, d.f.= 28, P = 0.73), RAVLT delay (F = 0.41, d.f.= 28, P = 0.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Neuropsychological functioningsham v. active tDCS

    Over the sham-controlled phase, a significant main effect of time was found for Stroop Interference, indicating that participants were quicker in performing the task at the end of the sham-controlled phase compared with baseline, but there was no interaction between group and time.

    “Over the sham-controlled phase, a significant main effect of time was found for Stroop Interference, indicating that participants were quicker in performing the task at the end of the shamcontrolled phase compared with baseline.However, there was no interaction between group and time (Table 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Mood outcomes

    The NNT was 16.7 for the 3-week active-sham comparison, and the NNT for 6 weeks' active tDCS compared with 3 weeks' sham stimulation was 2.6.

    “The NNT was 16.7 for the 3-week active-sham comparison.The NNT for 6 weeks' active tDCS compared with 3 weeks' sham stimulation was 2.6.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Mood outcomes

    There was no significant correlation between CORE scores and percentage change in MADRS scores over the 3-week active treatment period.

    “There was no significant correlation between CORE scores and percentage change in MADRS scores over the 3-week active treatment period.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Mood outcomes

    The same interaction only trended towards significance in QIDS-C scores and did not reach significance in the remaining mood outcome measures.

    “However, the same interaction only trended towards significance in QIDS-C scores and did not reach significance in the remaining mood outcome measures.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Adverse outcomes and side-effects

    During the sham-controlled phase, active tDCS was associated with side-effects including skin redness (n=30), tingling (n=26), itching (n=23), burning/heating sensation (n=14), headache (n=12), dizziness/light-headedness (n=10), fatigue (n=7), nausea (n=3), blurred vision (n=3), pain (n=2), pulsing sensation (n=2), neck soreness (n=1), visual effects when eyes closed (n=1), seeing dots in the per

    “During the sham-controlled phase, side-effects occurring during active treatment were skin redness (objectively observed) at the anode and/or cathode site (n = 30), tingling at anode and/or cathode site (n = 26), itching at anode and/or cathode site (n = 23), burning/heating sensation at anode and/or cathode site (n = 14), headache (n = 12), dizziness/light-headedness (n = 10), fatigue (n = 7),”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Mood outcomes

    A significant interaction between group and time was found in MADRS scores (the primary outcome measure), with simple effects indicating that there was a greater decrease in scores from baseline to the end of the sham-controlled phase in the active group (effect size: 0.49).

    “A significant interaction between group and time was found in MADRS scores (the primary outcome measure), with simple effects indicating that there was a greater decrease in scores from baseline to the end of the sham-controlled phase in the active group (Fig. 2) (effect size: 0.49).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Sham tDCS (1 mA for 30 s) has minimal stimulatory effects and is an inert control.
    • Rests on an assumption: The left dorsolateral prefrontal cortex is an appropriate target for antidepressant tDCS.

  • May combine two claims.

    Findingown data
    § Adverse outcomes and side-effects

    All side-effects were transient and mostly ranged from mild to moderate in intensity.

    “All side-effects were transient and mostly ranged from mild to moderate in intensity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Adverse outcomes and side-effects

    In addition, one participant experienced transient hypomania in the open phase and was subsequently withdrawn from the trial.

    “In addition, one participant experienced transient hypomania in the open phase and was subsequently withdrawn from the trial.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Mood outcomes

    Over the sham-controlled phase, four participants in both the active and sham groups met the criterion for response, and no participants in either group met the criterion for remission (MADRS score ≤10).

    “Over the sham-controlled phase, four participants in both the active and sham groups met the criterion for response.No participants in either group met the criterion for remission (MADRS score 510).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data
    § Conclusions

    Findings confirm earlier reports of the antidepressant efficacy and safety of tDCS.

    “Findings confirm earlier reports of the antidepressant efficacy and safety of tDCS.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Sham tDCS (1 mA for 30 s) has minimal stimulatory effects and is an inert control.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given
    § Statistical analysis

    Intention-to-treat last-observation-carried-forward scores were used for the analyses, and only participants with at least one post-baseline rating were included.

    “Intention-to-treat lastobservation-carried-forward scores were used for the analyses below.Only those participants with at least one post-baseline rating were included in the analyses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data
    § Efficacy

    Overall, this study confirmed previous reports of significant antidepressant effects with tDCS, with the active treatment group showing significantly greater improvement compared with the sham group over the 3-week study period on the primary outcome measure (change in MADRS).

    “Overall, this study confirmed previous reports of significant antidepressant effects with tDCS, with the active treatment group showing significantly greater improvement compared with the sham group over the 3-week study period on the primary outcome measure (change in MADRS).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Sham tDCS (1 mA for 30 s) has minimal stimulatory effects and is an inert control.

  • May combine two claims.

    Study design and conductown data
    § Integrity of masking

    When asked to guess their treatment assignment, correct responses were made by 14/24 participants in the active group and 16/25 participants in the sham group, and the chi-square test indicated no significant difference between groups in the likelihood of active/sham guesses (chi2=2.45, d.f.=1, P=0.12).

    “When asked to guess their treatment assignment, correct responses were made by 14/24 participants in the active group and 16/25 participants in the sham group.The w 2 -test indicated no significant difference between groups in the likelihood of active/sham guesses (w 2 = 2.45, d.f.= 1, P = 0.12).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § Participants

    In total, 58 participants completed the 15-session sham-controlled phase with 52 participants going on to complete the open-label phase.

    “In total, 58 participants completed the 15-session sham-controlled phase with 52 participants going on to complete the open-label phase (Fig. 1).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given
    § Study design

    Active or sham tDCS was administered every weekday (15 treatments in total), with participants and raters masked to group allocation.

    “Active or sham tDCS was administered every weekday (15 treatments in total), with participants and raters masked to group allocation.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data
    § Study design

    Participants were stratified by gender and age and randomly assigned by a computer-generated random sequence to active (n=33) or sham (n=31) treatment over a 3-week masked treatment phase.

    “Participants were stratified by gender and age and randomly assigned by a computer-generated random sequence to active (n = 33) or sham (n = 31) treatment over a 3-week masked treatment phase.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Introduction

    The effects of tDCS on neuronal excitability have been demonstrated in numerous neuroimaging and physiological studies, providing a sound neurobiological basis for its use for neuromodulation in patient populations.

    “The effects of tDCS on neuronal excitability have now been demonstrated in numerous neuroimaging and physiological studies, providing a sound neurobiological basis for its use for neuromodulation in patient populations.1,3”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] source

      Not checked in the free run.

    • cites [3] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data
    § Study design

    After screening and consent, participants were enrolled and allocated to treatment groups by research staff not involved in mood ratings, and treatment assignment was indicated by a code on study treatment sheets concealed from raters.

    “After being screened and signing consent, participants were enrolled and allocated to treatment groups by research staff who were not involved in mood ratings.The treatment assignment was indicated by a code on study treatment sheets, which were concealed from raters.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given
    § Efficacy

    This study reports the largest sample of individuals with current depression treated hitherto in a randomised controlled trial of tDCS.

    “This study reports the largest sample of individuals with current depression treated hitherto in a randomised controlled trial of tDCS.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Introduction

    In Loo et al (n=40, 1 mA, 20 min, 5 sessions on alternate days followed by 5 further active treatments), clinically meaningful improvement was seen with active tDCS over 10 sessions of treatment, but differences failed to reach statistical significance over the initial 5-session sham-controlled comparison period.

    “In Loo et al 7 (n = 40, 1 mA, 20 min, 5 sessions on alternate days followed by 5 further active treatments) clinically meaningful improvement was seen with active tDCS over 10 sessions of treatment, but differences failed to reach statistical significance over the initial 5-session sham-controlled comparison period.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7]

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data
    § Efficacy

    Results over the 3 weeks were clinically modest, with only a 28% decline in MADRS scores after active stimulation, a small proportion of responders (which did not differ between active and sham treatment groups) and active-sham differences failing to reach significance on the other mood rating scales.

    “However, results over the 3 weeks were clinically modest, with only a 28% decline in MADRS scores after active stimulation, a small proportion of responders (which did not differ between active and sham treatment groups) and active-sham differences failing to reach significance on the other mood rating scales.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Sham tDCS (1 mA for 30 s) has minimal stimulatory effects and is an inert control.

  • May combine two claims.

    Interpretationcitation
    § Efficacy

    These results in the active treatment group are comparable to those reported in the authors' earlier trial of tDCS (37% improvement after 10 sessions/3.5 weeks) and a recent open-label trial of tDCS (18% improvement in unipolar depression after 10 sessions/1 week).

    “These results in the active treatment group are comparable though, to those reported in our earlier trial of tDCS (37% improvement after 10 sessions/3.5 weeks) 7 and a recent open-label trial of tDCS (18% improvement in unipolar depression after 10 sessions/1 week).25”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7]

      Not checked in the free run.

    • cites [25] source

      Not checked in the free run.

    • Rests on an assumption: Sham tDCS (1 mA for 30 s) has minimal stimulatory effects and is an inert control.

  • May combine two claims.

    Premisecitation
    § Efficacy

    In the two trials with greater response, participants were free of medications prior to and during the trial, whereas in other trials and in this study, participants continued on antidepressant medication.

    “In the two trials with greater response, participants were free of medications prior to and during the trial (clarified in a personal communication from F. Fregni, March 2011), 5,6 whereas in others 7,25 and in this study, participants continued on antidepressant medication.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [5] source

      Not checked in the free run.

    • cites [6] source

      Not checked in the free run.

    • cites [7]

      Not checked in the free run.

    • cites [25] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction

    Transcranial direct current stimulation involves passing a weak, depolarising current through the brain, shifting the resting membrane potential, with anodal stimulation depolarising the soma of pyramidal cells and cathodal stimulation causing hyperpolarisation.

    “It involves passing a weak, depolarising current through the brain.This shifts the resting membrane potential, with anodal stimulation depolarising the soma of pyramidal cells, whereas cathodal stimulation results in hyperpolarisation. 2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given
    § Efficacy

    The studies above did not differ obviously in sample characteristics.

    “The studies above did not differ obviously in sample characteristics but did differ in permitting concurrent antidepressant medication during tDCS.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § Implications

    This trial confirmed earlier reports of the antidepressant efficacy and safety of tDCS.

    “In conclusion, this trial studied tDCS at stimulation parameters beyond those previously used in depression and confirmed earlier reports of the antidepressant efficacy and safety of tDCS.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning
    § Efficacy

    The influence of stimulus intensity and session frequency on efficacy of tDCS for depression is as yet unknown.

    “the influence of stimulus intensity and session frequency on efficacy are as yet unknown.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning
    § Efficacy

    The trials above also differed in stimulus intensity and session frequency.

    “The trials above also differed in stimulus intensity and session frequency.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Cognitive effects

    Fregni et al showed that five daily tDCS sessions enhanced performance on the Digit Span Forwards and Backwards test.

    “Previously, Fregni et al 32 showed that five daily tDCS sessions enhanced performance on the Digit Span Forwards and Backwards test,”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Efficacy

    The duration of stimulation has been shown to affect the duration of after effects.

    “Although the duration of stimulation has been shown to affect the duration of after effects, 27”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27]

      Not checked in the free run.

  • The quote only partly states this claim.

    Premiseown data
    § Cognitive effects

    We failed to replicate the finding that five daily tDCS sessions enhanced performance on the Digit Span Forwards and Backwards test in a larger sample.

    “a finding we failed to replicate in a larger sample.7”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given
    § Limitations and strengths

    The study had careful methodology with good participant adherence to the study protocol.

    “careful methodology with good participant adherence to the study protocol”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Limitations and strengths

    The study had a relatively large sample size.

    “Strengths of the study include the relatively large sample size,”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § Efficacy

    tDCS has meaningful antidepressant efficacy, including in those individuals resistant to pharmacotherapy.

    “This suggests that tDCS has meaningful antidepressant efficacy, including in those individuals resistant to pharmacotherapy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data
    § Cognitive effects

    Multiple tDCS sessions are safe and not associated with any adverse cognitive outcomes.

    “These results demonstrate that multiple tDCS sessions are safe and not associated with any adverse cognitive outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Efficacy

    Recent trials increased both stimulus intensity (2 mA) and session frequency (daily or twice daily) in an attempt to optimise outcomes.

    “Recent trials (Boggio et al, 6 this trial, Brunoni et al 25 ) increased both stimulus intensity (2 mA) and session frequency (daily or twice daily) in an attempt to optimise outcomes”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] source

      Not checked in the free run.

    • cites [25] source

      Not checked in the free run.

38 of 38

  • The paper relies on this without support.

    Sham tDCS (1 mA for 30 s) has minimal stimulatory effects and is an inert control.

    “For sham stimulation, a 1 mA current was applied for 30 s giving an initial sensation of tDCS while minimising stimulatory effects.”

  • The paper relies on this without support.

    The left dorsolateral prefrontal cortex is an appropriate target for antidepressant tDCS.

    “The tDCS was administered by an Eldith DC-stimulator (NeuroConn GmbH, Germany) with the anode over the left dorsolateral prefrontal cortex, identified as pF3 on the international 10/20 EEG (electroencephalogram) system, and the cathode placed over the lateral aspect of the contralateral orbit, at the F8 position (10/20 system).”

  • The paper relies on this without support.

    There are no safety issues with concurrent use of antidepressants and tDCS.

    “no evidence for safety issues with concurrent use of antidepressants and tDCS”

  • The paper relies on this without support.

    The continuation of medication while tDCS is introduced is likely to be the approach used if tDCS is eventually undertaken in clinical practice.

    “the continuation of medication while tDCS is introduced is likely to be the approach used if tDCS is eventually undertaken in clinical practice”

  • The paper relies on this without support.

    Withdrawal of medications may have caused clinical deterioration prior to study entry.

    “ethical and scientific concerns that withdrawal of medications may have caused clinical deterioration prior to study entry”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Multiple studies have shown successful sustained attentional enhancements in depressed samples via TMS, rTMS, and tDCS.

    “Multiple studies have shown successful sustained attentional enhancements in depressed samples via TMS133, rTMS134, and tDCS135.”

    From Paying attention to attention in depression (2019) · cites this paper as [135]

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Guy, 1976, Assessment Manual for Psychopharmacology – Revised
  2. Wechsler, 1981, WAIS-R Manual
  3. Wechsler, 1997, Wechsler Adult Intelligence Scale – Administration and Scoring Manual

Cited by

Sorted by citations

Related

Authors
Loo, C. K., Alonzo, A., Martin, D., Mitchell, P. B., Galvez, V., & Sachdev, P.
Affiliations
  • Black Dog Institute (AU)
  • UNSW Sydney (AU)
Corresponding author
Loo, Colleen K.
ORCID
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2012-01
Volume
200
Issue
1
Pages
52-59
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.bp.111.097634
OpenAlex
W2149430741
Semantic Scholar
0fe0c27b06144bee2af3c1559b90d82270473719
Cited by
455
References
33
Citations by year
2026: 10 · 2025: 10 · 2024: 31 · 2023: 17 · 2022: 19 · 2021: 25 · 2020: 35 · 2019: 34 · 2018: 33 · 2017: 37 · 2016: 49 · 2015: 49 · 2014: 32 · 2013: 43 · 2012: 31
FWCI
24.97
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 2193 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Health and Medical Research Council (510142)
Topics
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
transcranial direct current stimulation, depression, antidepressant efficacy, anodal tDCS, left prefrontal cortex, mood improvement, attention, working memory, neuropsychological outcomes, bipolar disorder, hypomania, mood switching
MeSH terms
Adult, Analysis of Variance, Attention, Depressive Disorder, Major, Major Depressive Disorder, Double-Blind Method, Electric Stimulation Therapy, Female, Humans, Male, Memory, Short-Term, Middle Aged, Neuropsychological Tests, Psychiatric Status Rating Scales, Severity of Illness Index, Time Factors, Treatment Outcome, Prefrontal Cortex

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review