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01-19 Transcranial DC stimulation effective add-on therapy for bipolar depression, suggests study

Transcranial DC stimulation effective add-on therapy for bipolar depression, suggests study

The last few years have seen an increasing interest in non-invasive brain stimulation techniques. Among these techniques, transcranial direct current stimulation (tDCS) has received greater attention due to its ease of use, low cost, encouraging results and a low rate of side effects. This has led to tDCS being tested in several studies and randomized clinical trials, especially for psychiatric disorders. Previous studies have found promising results of tDCS in the treatment of major depressive disorder (MDD), also called unipolar depression.

The positive results of using tDCS encouraged a team of researchers to study its effectiveness in the treatment of bipolar depression (BD). Researchers at the University of São Paulo (USP), Brazil, conducted a randomized, sham-controlled double-blind study called the Bipolar Depression Electrical Treatment Trial (BETTER). Results of the study, published in the journal JAMA Psychiatry in December 2017, found that tDCS was a safe and effective add-on therapy for bipolar depression. It was observed that active tDCS resulted in “superior depression improvement and higher response rates” compared to sham tDCS.

The researchers also found that compared to sham tDCS, active tDCS did not induce further manic/hypomanic episodes. The participants included 59 adults (mean age 45.9 years) with type I or II bipolar disorder in a major depressive episode (MDE); 40 of them were women, and overall 52 people completed the trial. The participants were on a stable medication regimen, and had scored greater than 17 on the Hamilton Depression Rating Scale (HAM-D or HDRS).

Existing treatments for bipolar only mildly effective

According to the researchers, the existing treatments for BD are only mildly effective. The resulting side effects may often force individuals to discontinue treatment. Study author Andre R. Brunoni, a psychiatrist and coordinator at the Interdisciplinary Center for Applied Neuromodulation at the USP, highlighted the need for “novel treatment options.” None of the adverse impacts observed during the trial met the criteria of an MDE with mixed features, hypomania or mania, nor did they require hospitalization, trial discontinuation or specific treatment.

Bipolar depression is often misdiagnosed, especially initially, which results in ineffective treatment and worsening of the disorder. Past research highlighted the challenges faced in the treatment of bipolar depression. It also questioned the effectiveness of using antidepressants, a common intervention in treating the disorder, as the first line of treatment. Using a combination of mood stabilizers was found to be more effective than the combination of a mood stabilizer and an antidepressant. However, other studies recommended using a combination of drugs and psychosocial treatments.

Bipolar depression in adolescents/teens

Bipolar depression is characterized by dramatic changes in an individual’s mood, energy and ability to form clear thought processes. Symptoms of the disorder include high and low moods, called mania and depression, respectively, which are different from regular mood swings. It has been previously estimated that 2.5 percent of youth aged between 13 and 18 years met the criteria for bipolar disorder in their lifetime, and 2.2 percent met the criteria within a given year. Rates were found to increase with age; nearly 2 percent younger teens reported symptoms compared to 3.1 percent older teens.

Children with a family history of bipolar disorder have a four- to six-time higher likelihood of developing the illness (although most don’t), compared to their peers. Early-onset bipolar – which starts in childhood or adolescence – appears to be more severe than what is observed in older teens and adults. Youth with BD seem to have a higher frequency of mood swings, fall sick more often and have more mixed episodes.

Treatment for teen bipolar depression

People with early-onset BD have a higher risk of attempting suicide compared to those whose symptoms appear during adulthood. Many children with bipolar disorder also have a history of attention-deficit hyperactivity disorder (ADHD), anxiety disorders, other mental disorders and alcoholism. While there is no single treatment for the illness, medications, psychotherapy or a combination of both can help alleviate the symptoms.

If your teen child is struggling with bipolar depression or related symptoms, help is available. Sovereign Health of Rancho San Diego specializes in treating teenage bipolar depression. Call our 24/7 helpline number or chat with our online representatives for more information on treatment of bipolar depression in teens.

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