Elsevier

Biological Psychiatry

Volume 73, Issue 7, 1 April 2013, Pages 646-651
Biological Psychiatry

Archival Report
Amelioration of Cognitive Control in Depression by Transcranial Direct Current Stimulation

https://doi.org/10.1016/j.biopsych.2012.10.010Get rights and content

Background

Deficient cognitive control over emotional distraction is a central characteristic of major depressive disorder (MDD). Hypoactivation of the dorsolateral prefrontal cortex (dlPFC) has been linked with this deficit. In this study, we aimed to enhance the activity of the dlPFC in MDD patients by anodal transcranial direct current stimulation (tDCS) and thus ameliorate cognitive control.

Methods

In a double-blinded, balanced, randomized, sham-controlled crossover trial, we determined the effect of a single-session tDCS to the left dlPFC on the cognitive control in 22 MDD patients and 22 healthy control subjects. To assess the cognitive control, we used a delayed response working memory task with pictures of varying content (emotional vs. neutral) presented during the delay period.

Results

Emotional pictures presented during the delay period impaired accuracy and response time of patients with MDD, indicating an attentional bias for emotional stimuli. Anodal tDCS to the dlPFC was associated with an enhanced working memory performance both in patients and control subjects. Specifically in subjects with MDD, the attentional bias was completely abolished by anodal tDCS.

Conclusions

The present study demonstrates that anodal tDCS applied to the left dlPFC improves deficient cognitive control in MDD. Based on these data, tDCS might be suitable to support the effects of behavioral training to enhance cognitive control in MDD.

Section snippets

Participants

Twenty-two patients with MDD were recruited via announcements, as well as through outpatient clinics and a psychiatric clinic. Patients were diagnosed according to DSM-IV criteria using the Structured Clinical Interview for DSM-IV. Psychopathology was further assessed with the Beck Depression Inventory and the 21-item Hamilton Depression Scale. Subjects who met criteria (current or lifetime) for a schizophreniform disorder, a bipolar disorder, addiction or substance abuse (the latter within 3

Results

All subjects completed the entire experiment. At the beginning of stimulation, most subjects reported the typical initial tingling, predominantly under the scalp electrode. No adverse effects such as pain, skin burns, irritation, or headache were reported during or after tDCS.

Discussion

This study provides first evidence that anodal tDCS applied to the left dlPFC ameliorates deficient cognitive control specifically present in patients with MDD. Since deficient cognitive control has been consistently linked with the onset and maintenance of depression (3), its recovery during anodal tDCS supports the idea that noninvasive brain stimulation may be an effective tool to directly enhance the clinical outcome of cognitive behavioral interventions in MDD 18, 32.

In addition, our data

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