Transcranial Direct Current Stimulation (tDCS): The Most Effective Treatment for Depression You’ve Never Heard Of

Timothy Sexton has been covering tDCS on the Yahoo Contributor Network.

You name an antidepressant and I have tried it. I have even been on the verge of getting electro-convulsive therapy to treat my depression. And yet not once-not one single time-have I ever heard any of these doctors bring up transcranial direct current stimulation or use the term tDCS.

As a writer and a victim of clinical depression, I have collected a small library of books related to health concerns. Many of these books specifically focus on alternatives to mainstream American approaches to treating illnesses. Not a single one of these books mentions tDCS at all. Not for improving cognition, not for treating pain and not for treating depression. Nada. Nothing. Zilch.

He ends the article with…

I am going to be undergoing tDCS treatment for depression myself and follow-ups to this article will provide a first-person investigation into how this alternative treatment actually affects mood and behavior.

I’ll be keeping an eye out for Timothy’s follow-up.

via Transcranial Direct Current Stimulation (tDCS): The Most Effective Treatment for Depression You’ve Never Heard Of – Yahoo! Voices – voices.yahoo.com.
See Also: Treatment of depression with transcranial direct current stimulation (tDCS): A Review (pdf)

tDCS Clinical Trials Seeking Volunteers

There seems to be a LOT of activity going on in the medical profession around tDCS. You can monitor ClinicalTrials.gov to keep an eye on new and recruiting tdcs studies. If you start here and modify your search with your location, you may find a study in your area.

Devices mentioned in the studies:
Eldith DC stimulator (13 mentions) [Also translated from the German neuroconn.de]
Magstim Company Ltd. UK (1 mention)
Soterix tDCS device (1 mention)

8 Recruiting Brain Stimulation-aided Stroke Rehabilitation: Neural Mechanisms of Recovery

Condition: Stroke
Interventions: Procedure: tDCS: noninvasive brain stimulation;   Behavioral: Constraint induced movement therapy (CIMT);   Procedure: Sham tDCS: placebo noninvasive brain stimulation
9 Recruiting Effects of Transcranial Direct Current Stimulation (tDCS) on Chronic Pain Due to Burn Injury

Conditions: Pain;   Burn Injury
Intervention: Device: Transcranial Direct Current Stimulation (tDCS)
10 Recruiting Anodal Transcranial Direct Current Stimulation (tDCS) in the Treatment of Tobacco Addiction

Conditions: Behavior, Addictive;   Smoking
Interventions: Procedure: sham tDCS;   Procedure: active tDCS

Some interesting finds from the tDCS SubReddit

Ranza, over at the tDCS SubReddit has a tDCS device and has found the perfect online resource for running tests. The Cambridge Brain Science website. One of their stated goals is:

To provide a web-based platform for the controlled assessment of cognitive function in targeted groups of individuals for the purposes of scientific investigation, including clinical and pharmaceutical trials. The Cambridge Brain Sciences platform has recently been used by a major pharmaceutical company to conduct an entirely web-based trial of a novel compound. Clinical trials involving various patient groups are also underway.

(Would like to know more about this ‘novel compound’.) And here’s an example of one of the tests.

The Odd One Out task differers from Raven’s and Cattell’s intelligence tests as the problems are generated on the fly using a complex set of algorithms. Due to this on the fly generation, and the ability of the task to generate many tens of thousands of novel problems, the task is suitable for training reasoning abilities or taking many repeated measures as the participants cannot learn the answers to specific problems by rote. Instead, they must solve a novel set of problems each time they undertake the task.

This seems to me the perfect solution for a standardized set of tests to measure our performance while using tDCS devices. What remains is some sort of methodology for setting up the electrodes. PS. I don’t own a tDCS device yet.

Start Testing Now!

I think that for me, the thing to do now that I’ve found http://www.cambridgebrainsciences.com, even before I have a tDCS device, is to see if I can affect my test score outcomes using a variety of ‘brain hacks’. For example, this list from Jonah Lehrer http://www.wired.co.uk/magazine/archive/2012/05/features/the-new-rules-of-creativity?page=all Jonah also mentions in various podcasts I’ve listened to around the release of his latest book, “Imagine, How Creativity Works” that both cannabis and alcohol can improve performance on certain kinds of challenges. (Those benefiting from an active right hemisphere.) Imagine having tested sufficiently to be able to state, for instance, that: Under the influence of two 12oz bottles of Guinness consumed within a period of 30 minutes, I was able to increase my Monkey Ladder score by a solid 10%.

From the same Jonah Lehrer Wired article…

When it’s looked in all the obvious places to no avail, you experience mental deadlock. This is a signal to the brain that a new search process is required.

2. Brain activity now shifts to the right hemisphere. According to neuroscientist Mark Beeman, this side is responsible for seeing the big picture. Now you can grasp subtle connotations — the punchline of a joke or the meaning of a metaphor. The switch allows you to explore unexpected associations and perspectives.

3. Thirty seconds before your “aha” moment, there is a sudden burst of brain activity called a “gamma-wave rhythm” which, says Beeman, is the highest electrical frequency generated by the brain. It comes from neurons forming new connections. The spurt of activity comes from the anterior superior temporal gyrus, located on the right hemisphere, just above the ear.

Unlock Your Inner Rain Man by Electrically Zapping Your Brain | Wired Science | Wired.com

Alan Snyder is director of Center For The Mind, an Australian research group that has published widely. He’s the co-founder of CreativityCap.com, a website that posits the possibility of accessing the ‘Mind’s Hidden Secrets’.

Snyder and Chi had their subjects attempt to solve the problem while wearing an electrode cap. After a few minutes without brain stimulation, half of the subjects received stimulation while the other half received no stimulation. Here’s the interesting part: Whereas none of the subjects solved the problem before brain stimulation, more than 40 percent of subjects in the stimulation group solved the problem after being zapped. Talk about being struck by inspiration.

In case you’re imagining some kind of Frankensteinian setup for electrifying people’s brains, it’s nothing like that. The technique, called transcranial direct current stimulation (tDCS), involves applying a weak electrical current to the scalp through a pair of electrodes on sponges. It’s a widely used technique that is considered safe, with minor side effects. Other researchers have shown cognitive improvements using the same method applied to other brain areas, but Snyder and Chi are the first to use stimulation to mimic savant brain physiology.

via Unlock Your Inner Rain Man by Electrically Zapping Your Brain | Wired Science | Wired.com.

Mind Alive – Dave Siever

Update: Spent a lot of time tracking down the Eldith device today and wherever I found it there was no mention of price. Dave Siever does mention the price and features in comparison to the device his company makes and I thought you might find it interesting. Not sure how much has changed since this was written.

There are presently only two stand-alone devices that produce tDCS. They are: the Eldith DC Stimulator by Neuro Conn, of Germany, which sells for €3000 (about $4,000US) and the CESta, by Mind Alive Inc., of Canada, which sells for $350US. [now $450. + accessories] Both units are current controlled and programmable. The CESta has the added benefits of providing cranio-electro stimulation and micro-electro therapy for muscle work. It also features randomization of the frequency stimulation and usage tracking for patient compliance. The CESta has been “tuned” with the electrodes provided so that at 1 ma stimulation, the active electrode delivers 50 µa/cm2, while the reference electrode produces 18 µa/cm2. This table shows the current density using various sizes at 1 and 2 ma currents.

25 cm2  5 x 5     @         1 ma     =          40 µa/cm2

25 cm2  5 x 5     @         2 ma     =          80 µa/cm2

36 cm2  6 x 6     @         1 ma     =          27 µa/cm2

49 cm2  10 x 10 @         1 ma     =          20.4 µa/cm2

You have to wonder about a tDCS device that doubles as a colloidal silver maker, but in the interest of ‘covering the field’ I wanted to post this video of Mind Alive’s Dave Siever discussing tDCS.

http://www.youtube.com/watch?v=f3eAU5aXQ9E

The photos and diagrams used in the talk can be found here. Mind Alive has a large collection of tDCS related papers and articles available to download (zip file of pdfs).

Mind Alive sells a variety of devices including what I believe are called ‘Mind Machines’-devices intended to alter your brainwaves using light and sound. One of their devices, the Oasis Pro can also be used for tDCS.

10/20 System Electrode Distances

Trans Cranial Technologies offer this manual which explains the International 10/20 system for describing the location of scalp electrodes. 10/20 System Positioning (pdf) See Also: Wikipedia, Electrode Positions

The system is based on the relationship between the location of an electrode and the underlying area of cerebral cortex. The numbers ‘10’ and ‘20’ refer to the fact that the distances between adjacent electrodes are either 10% or 20% of the total front- back or right-left distance of the skull.
Each site has a letter to identify the lobe and a number to identify the hemisphere location.

Also from Trans Cranial Technologies, Cortical Functions Reference

Brodmann Cortical Areas

 

Transcranial direct current stimulation in the treatment of depression | Medicographia

This is the single example of the frequently sited Eldith device matched to a photo of the device. I’m not sure if perhaps neuroConn changed the name of the device, or…?

 

Transcranial direct current stimulation (tDCS)

_ Mechanism of action
Contemporary tDCS protocols typically involve the application of a 1 mA or 2 mA direct current (DC) for up to 20 minutes between two surface electrodes. These may vary in size, but are commonly _35cm2 (5×7 cm). The electrodes are placed on the scalp, one serving as the anode and the other as the cathode. Current flows from the anode to the cathode, some being diverted through the scalp and some moving through the brain.15

Figure 2
Figure 2. Eldith transcranial direct current stimulation (tDCS)
stimulator with electrodes. Photo by the author.

Figure 3

via Transcranial direct current stimulation in the treatment of depression | Medicographia.

t.D.C.S. Update Could remission be within my reach and your’s too? – NeuroTalk Support Groups

Worth reading the whole thread. For this person with Complex regional pain syndrome (CRPS is a chronic pain condition that can affect any area of the body, but often affects an arm or a leg) tDCS seems to be very effective. She mentions it having a positive effect on her Tinnitus as well. Can you imagine the impact if tDCS turned out to be beneficial in treating Tinnitus? I’d like to point out that anyone can say anything on a forum and this post feels a little ‘too good to be true’ to me.

In only one week of treating myself for twenty minutes twice a day my tinnitus has vanished, my teeth clenching due to pain is reduced, my posture is improving, my right hand is no longer clenched. I am no longer sleeping with a bungee cord attached to my wrist and the bottom of my bed to keep my arm from curling up for eight hours at a time. I am able to wear a top for up to an hour and a half. That’s right-I can’t wear anything on my upper body for any extended period of time- which means I am confined to one room of the house with a space heater, only half clothed My range of motion is improving. Yesterday I unloaded the dishwasher for the first time in three years! Typically my body is covered in bruises because of falls. Although I have bruises on my abdomen and legs from a fall prior to beginning treatment about a week ago I have not fallen since I began treatment. By evening I am usually wiped and feeling irritable so I excuse myself and take an epson salts bath. For the past three evenings my husband has enjoyed my company so much that he insists I still take the bath but he comes in the room with me.Two days ago was a most dreary raining and gray day. I looked out the kitchen door and noticed the poison ivy vine curling its way up the downspout. It had been a constant source of aggravation because I could not pull or dig it up. Suddenly is was a gorgeous orange and gold work of art. When I looked past it down the street I noticed the red and gold trees against the gray sky. The were absolutely beautiful. I had not noticed one single color of fall.

Later in the thread she gives more details about the device.

The equipment used for my original treatment at Beth Israel in NYC was an Ionto Phoresis unit by Iomed. By the time I decided to treat myself this particular unit had been discontinued. The unit I use now is advertised as the replacement unit for the Iomed model. The device is a Trivarion Activa Dose Phoresor. The wires needed are standard TENS unit wires. The electrodes are square sponge electrodes, which must be soaked in Saline solution. They are held in place with ace bandages.

Which I believe can be found here. Note that this device is not made specifically for tDCS but is, I believe, an Iontophoresis device. It has a Maximum Voltage of 80V DC! Not something to be fooling around with.

Iontophoresis (a.k.a. Electromotive Drug Administration (EMDA)) is a technique using a small electric charge to deliver a medicine or other chemical through the skin. It is basically an injection without the needle. The technical description of this process is a non-invasive method of propelling high concentrations of a charged substance, normally a medication or bioactive agent, transdermally by repulsive electromotive force using a small electrical charge applied to an iontophoretic chamber containing a similarly charged active agent and its vehicle.
via t.D.C.S. Update Could remission be within my reach and your’s too? – NeuroTalk Support Groups.

Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation

This is a paper from Drs. Nitsche and  Paulus at the University of Goettingen in 2000. I gather that this paper was responsible for the resurgence of interest in tDCS.

Abstract
In this paper we demonstrate in the intact human the possibility of a non-invasive modulation of motor cortex excitability by the application of weak direct current through the scalp.
Excitability changes of up to 40 %, revealed by transcranial magnetic stimulation, were accomplished and lasted for several minutes after the end of current stimulation.
Excitation could be achieved selectively by anodal stimulation, and inhibition by cathodal stimulation.
By varying the current intensity and duration, the strength and duration of the after-effects could be controlled.
The effects were probably induced by modification of membrane polarisation. Functional alterations related to post-tetanic potentiation, short-term potentiation and processes similar to postexcitatory central inhibition are the likely candidates for the excitability changes after the end of stimulation. Transcranial electrical stimulation using weak current may thus be a promising tool to modulate cerebral excitability in a non-invasive, painless, reversible, selective and focal way.

via Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation.
Full Paper Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation

DRUM: Understanding Neuroplastic Effects of Transcranial Direct Current Stimulation through Analysis of Dynamics of Large-Scale Brain Networks

We’ll have to wait until June 2013 to read the dissertation however.

…Results from Study 1 using model-free analysis showed that a specific fronto-parietal network at rest was modulated up to a period of 30 minutes outlasting the duration of the stimulation. Further model-based analysis of this fronto-parietal network showed that these differences were driven by network activity primarily involving high frequency gamma band connectivity to and from the supplementary motor area to associated regions left primary motor cortex stimulated region, left prefrontal and parietal cortices. Results from Study 2 showed that the tDCS exerts highly polarity-specific effects on the impact of oscillatory network connectivity, within the functionally relevant fronto-parietal network, on behavioral changes associated with motor learning. These results advance our understanding of neuroplasticity mediated by tDCS and thus, have implications in the clinical use of tDCS for enhancing efficacy of neurorehabilitation in patients with stroke and traumatic brain injury.

URI: http://hdl.handle.net/1903/12741

via DRUM: Understanding Neuroplastic Effects of Transcranial Direct Current Stimulation through Analysis of Dynamics of Large-Scale Brain Networks.

CES (Cranial electrotherapy stimulation) Devices Currently (Ha!) Available

Turns out there are numerous ‘FDA Cleared’ CES (cranial electrotherapy stimulation AC) devices available for sale in the U.S. when recommended and prescribed by your doctor. Typically these devices are recommended for pain but also for depression. They also seem to be recommended for use in drug treatment. Cost of the device is sometimes covered by insurance.

[Video was removed from Youtube] That clip shows both the Fisher Wallace Stimulator and the Alpha-Stim devices.

More from Fisher Wallace. [Video was removed from Youtube]

Also for doctors: How to prescribe the device.

http://www.youtube.com/watch?feature=player_embedded&v=dOZ3Ktg04vY

A couple of other available devices: CES Ultra and European manufacturer Onko Cet offers the Transair series of transcranial electrostimulation (TES) devices.

 

tDCS and CES – A Little History

Is a way to think about the effects of tDCS then, that it increases neuronal ‘excitability’?
Interesting too, the possibility that AC stimulation might actually be affecting neurotransmitter production.

From: Noninvasive Brain Stimulation with Low-Intensity Electrical Currents: Putative Mechanisms of Action for Direct and Alternating Current Stimulation [PDF}

As early as 1794, Aldini had assessed the effect of galvanic head current on himself, and by 1804, he had reported the successful treatment of patients suffering from melancholia. Research continued through the early 20th century; yet because DC induced variable results, or sometime none at all, the use of low-intensity DC (i.e., tDCS) was progressively abandoned…

…between 1938 and 1945, subsequently led to an interest in the application of AC at lower intensities with the first study of “cranial electro-therapy stimulation” (also known as “electrosleep”) published by Anan’ev and others in 1957… Since the 1960s, a series of studies with low-intensity AC stimulation have been published, and cranial AC stimulation devices have become commercially available for personal use (e.g., Alpha-Stim, Fisher Wallace Cranial Stimulator, Transair Stimulator, etc.). However, research in this area has been inconsistent and there remains a lack of solid evidence showing the effects of weak transcranial stimulation with AC.

…During tDCS, low-amplitude direct currents penetrate the skull to enter the brain. Although there is substantial shunting of current at the scalp, sufficient current penetrates the brain to modify the transmembrane neuronal potential and, thus, influences the level of excitability and modulates the firing rate of individual neurons. DC currents do not induce action potentials; rather, the current appears to modulate the spontaneous neuronal activity in a polarity-dependent fashion: For example, anodal tDCS applied over the motor cortex increases the excitability of the underlying motor cortex, whereas cathodal tDCS applied over the same area decreases it. Similarly, anodal tDCS applied over the occipital cortex produces short-lasting increases in visual cortex excitability. Hence, tDCS is believed to deliver its effects by polarizing brain tissue, and although anodal stimulation generally increases excitability and cathodal stimulation generally reduces excitability, the direction of polarization depends strictly on the orientation of axons and dendrites in the indu- ced electrical field.

CES is a nonstandardized and often indistinct method of delivering cranial AC stimulation; indeed many studies cite the method of stimulation simply as “cranial electrotherapy stimulation” without identifying the specific site or other parameters of stimulation (e.g., duration, current density, intensity, electrode size) calling into question existing reviews of this method. Even so, CES has been suggested to be effective in the treatment of anxiety, depression, stress, and insomnia, and the following parameters of stimulation have been reported: frequency (0.5 Hz to 167 kHz), intensity (100 μA to 4 mA), and duration of stimulation (5 min to 6 consecutive days).

… Biochemical changes—neurotransmitter and endorphin release. Several studies suggest that AC stimulation may be associated with changes in neurotransmitters and endorphin release. In this context, subthreshold stimulation induced by AC stimulation would indeed cause significant changes in the nervous system electrical activity.

For further reading on CES (AC stimulation) the wikipedia page is quite good!