Combining TMS or tDCS With Certain Medications May Reduce MDD Symptoms
Combining certain medications or psychotherapy with transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) may decrease symptoms of major depressive disorder (MDD), though some limitations still exist, according to a review published in the Harvard Review of Psychiatry.
Researchers pulled information from 3 databases: PubMed, PsycInfo, and Cochrane Library. The initial search revealed 2519 records; after screening and review, 58 total studies were included (7 TMS plus psychotherapy, 32 TMS plus medication, 7 tDCS plus psychotherapy, 12 tDCS plus medication).
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Alongside original findings of MDD symptom improvement when combining TMS or tDCS with medication or psychotherapy, researchers also found evidence for other strategies:
- When adding TMS to an ongoing medication regimen, clinicians should use a phased approach by starting with 1 or 2 Hz and increasing to 10 Hz if necessary.
- Starting citalopram at 20 to 40 milligrams per day with TMS may increase symptom reduction 1 to 2 weeks in and continuing through the end of treatment.
- Combining sertraline 50 mg/day with 30-minute sessions of tDCS may significantly reduce MDD symptoms, especially with more severe cases of MDD.
- Benzodiazepines may interfere with TMS and tDCS response, and antipsychotics can interfere with TMS response as well.
Authors noted that their results do come with a few limitations, the first being that tDCS is not yet FDA approved. Moreover, authors reported that many of the studies included in the review had small sample sizes or were short-term and the larger studies lacked a control group.
“Given the potential side effects of adding medications, and the effort and time required to engage in psychotherapy, such additional interventions need to confer benefits beyond what TMS or tDCS offers alone. Crucially, randomized controlled trials are necessary to move the field forward," noted authors Tina Chou, PhD, and Darin Dougherty, MD. “Future studies need to enroll larger samples, include randomized controlled study designs, create more uniform protocols for combined treatment delivery, and explore mechanisms and predictors of change.”
