TRANSCRANIAL DIRECT CURRENT STIMULATION

Transcranial Direct Current Stimulation (tDCS) is a form of non-invasive brain stimulation that uses a weak electric current to create functional changes (i.e. neuroplasticity) in the underlying brain tissue. The mechanisms behind tDCS is as follows: Your brain is a vast interconnected circuit of around 100 billion neurons. Each neuron has around 7000 synaptic connections to other neurons, adding up to over 1000 trillion connections. The neurons communicate with each other via electrical discharges. Applying a weak current via tDCS can make the targeted neural pathways more or less likely to fire, in other words, strengthening or weakening the synaptic transmission, which is the cellular basis of learning.

 

A tDCS device is a small battery powered device with two connected electrodes that are placed on the scalp and held into place. When the stimulator is turned on, current flows from the device to the electrodes and subsequently through the brain. tDCS is a safe, painless and well-tolerated procedure that has been shown to provide relief in many people with chronic conditions such as depression and pain. Most people describe tDCS as feeling like a tingling sensation. Please see below for its potential side effects.

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Dr Cara Wong uses Sooma tDCS™ technology developed in Finland (https://soomamedical.com/en/). This is a medical device used by healthcare professionals worldwide and has TGA approval here in Australia.

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What is the evidence?

Over the last few decades, research has shown tDCS to be an effective and affordable treatment of major depressive disorder, with no major side effects. Reviews of randomised controlled trials of tDCS in depression found that stimulation of the left frontal lobe led to a significant reduction of depressive symptoms compared to a placebo treatment, with similar efficacy to anti-depressant medication. 

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tDCS has also been shown to be an effective opioid-free pain relief to patients with chronic pain conditions, with no adverse effects. Reviews have found that tDCS over the primary motor cortex led to significant reductions in pain compared to a placebo treatment in patients with fibromyalgia and neuropathic pain after spinal cord injury. The therapy has also led to significant quality of life improvements in patients with chronic neuropathic pain (nerve pain).

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Encouraging results have also emerged for its benefits in people with dementia, Parkinson’s disease, tinnitus, anxiety, obsessive compulsive disorder (OCD) and substance use disorders. Further research is needed though to prove its clinical efficacy in these other disorders.

 

What does a tDCS treatment program look like?

tDCS treatment is typically applied for 30 minutes, 5 days a week, for a minimum of 2 weeks. A cap with two electrodes are placed over the head, while you sit comfortably. You are completely alert and awake during the treatments, and during the treatment you may engage in other quiet, relaxing activities such as reading, listening to music/meditation/podcast etc. tDCS treatment can be used as a standalone or in combination with pharmaceutical and/or psychological therapy. 

 

What are the benefits of tDCS?

Positive effects of tDCS have been shown in just two to three weeks in the treatment of depression and chronic pain. Unlike pharmacological treatments there have been no serious side-effects reported from tDCS in 20 years of scientific studies. tDCS is painless and can be used to augment medication or psychotherapy, or as a treatment on its own. Patients who do not get an adequate response from medication may also benefit from tDCS therapy. 

 

What are the side effects?

The most common side effects of tDCS are mild and short-lived. The side effects include skin reddening, itching, tingling, headache and discomfort. In the 2015 tDCS review and recommendations from an expert panel document, there were no serious events attributable to tDCS reported in more than 10,000 subjects investigated in the contemporary tDCS literature (between 1998-2004). Nonetheless, there are safety parameter guidelines for treatment that are followed by our clinic.

 

Who can use tDCS treatment?

We are currently providing tDCS treatments to clients diagnosed with major depressive disorder and chronic pain. Contraindications for the therapy are metal implants within the skull, a pacemaker, head/brain surgery within the last 6 months, history of epilepsy or seizures, and acute eczema in the stimulation area. As there is currently little research into treating children/adolescents, we are only using tDCS treatment in adults who are able to give informed consent in our clinic.

 

As we offer a take-home device, clients must be able to function independently and understand/follow instructions well.

 

If you are interested in tDCS treatment please contact us. You can also find our brochure here.

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References​

• Brunoni, Andre R., et al. "Transcranial direct current stimulation for acute major depressive episodes: meta-analysis of individual patient data." The British Journal of Psychiatry 208.6 (2016): 522-531.

• Mehta, Swati, et al. "Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis." Spinal Cord 53.11 (2015): 780.

• Meron, Daniel, et al. "Transcranial direct current stimulation (tDCS) in the treatment of depression: systematic review and meta-analysis of efficacy and tolerability." Neuroscience & Biobehavioral Reviews 57 (2015): 46-62.

• Moffa, Adriano H., et al. "Efficacy and acceptability of transcranial direct current stimulation (tDCS) for major depressive disorder: an individual patient data meta-analysis." Progress in Neuro-Psychopharmacology and Biological Psychiatry 99 (2020): 109836.

• Mutz, Julian, et al. "Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: a systematic review and meta-analysis of randomised sham-controlled trials." Neuroscience & Biobehavioral Reviews 92 (2018): 291-303.

• Razza, Lais B., et al. "A systematic review and meta‐analysis on the effects of transcranial direct current stimulation in depressive episodes." Depression and Anxiety 37.7 (2020): 594-608.

• Shiozawa, Pedro, et al. "Transcranial direct current stimulation for major depression: an updated systematic review and meta-analysis." International Journal of Neuropsychopharmacology 17.9 (2014): 1443-1452.

• Sooma White Paper : https://soomamedical.com/wp-content/uploads/2019/06/C17A09-EN-White-paper-1.pdf

• Zhu, Chang-E., et al. "Effectiveness and safety of transcranial direct current stimulation in fibromyalgia: a systematic review and meta-analysis." Journal of rehabilitation medicine 49.1 (2017): 2-9.