Highlights
- •This RCT examines the efficacy of add-on anodal tDCS for SSRI resistant OCD.
- •Target region was pre-supplementary motor area.
- •The response rate was significantly greater in the true tDCS arm.
- •tDCS shows promise for its use in SSRI resistant OCD.
Abstract
Background
A significant proportion of obsessive compulsive disorder (OCD) patients do not respond
to specific serotonin reuptake inhibitors (SSRIs). There is a need to evaluate novel
treatment options for OCD.
Objective
In this double blinded, randomized, sham controlled study, we investigated the efficacy
of add-on transcranial direct current stimulation (tDCS) in reducing the symptoms
in SSRI-resistant OCD patients by employing anodal pre-supplementary motor area (pre-SMA)
stimulation.
Method
Twenty-five patients with DSM-IV OCD having persistent symptoms despite adequate and
stable treatment with at least one SSRI were randomly allocated to receive 20 min
of verum (active) 2-mA tDCS or sham stimulation twice daily on 5 consecutive days
[anode over Pre-SMA; cathode over right supra-orbital area]. Response to treatment
was defined as at least 35% reduction in the Yale-Brown Obsessive-Compulsive Scale
(YBOCS) total score along with a Clinical Global Impression – Improvement (CGI-I)
score of 1 (very much improved) or 2 (much improved).
Results
The response rate was significantly greater in the verum tDCS(4 out of 12) compared
to sham-tDCS (0 out of 13) [Fisher's exact test, p = 0.04]. Repeated measures analysis
of variance with tDCS type (verum vs. sham) as between subjects factor showed that
there was a significant tDCS-type X time-point interaction with significantly greater
reduction of YBOCS total score [F (1,22) = 4.95,p = 0.04,partial-η2 = 0.18] in verum-tDCS group.
Conclusions
The results of this RCT suggest that tDCS may be effective in treating SSRI-resistant
OCD. Future studies should examine the efficacy in larger samples of OCD and explore
other potential target regions using randomized sham-controlled designs, in addition
to examining the sustainability of the beneficial effects.
Trial registration
Clinical Trials Registry India (http://ctri.nic.in/Clinicaltrials/login.php): Registration Number- CTRI/2016/04/006837).
Keywords
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Article info
Publication history
Published online: February 13, 2019
Accepted:
February 10,
2019
Received in revised form:
January 28,
2019
Received:
June 9,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
