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Efficacy and safety of transcranial direct current stimulation as an add-on treatment for obsessive-compulsive disorder: a randomized, sham-controlled trial

Abstract

Obsessive-compulsive disorder (OCD) is a frequent, disabling disorder with high rates of treatment resistance. Transcranial direct current stimulation (tDCS) is a safe, tolerable noninvasive neuromodulation therapy with scarce evidence for OCD. This double-blind, randomized, and sham-controlled study investigates the efficacy of tDCS as add-on treatment for treatment-resistant OCD (failure to respond to at least one previous pharmacological treatment). On 20 consecutive weekdays (4 weeks), 43 patients with treatment-resistant OCD underwent 30 min active or sham tDCS sessions, followed by a 8 week follow-up. The cathode was positioned over the supplementary motor area (SMA) and the anode over the left deltoid. The primary outcome was the change in baseline Y-BOCS score at week 12. Secondary outcomes were changes in mood and anxiety and the occurrence of adverse events. Response was evaluated considering percent decrease of baseline Y-BOCS scores and the Improvement subscale of the Clinical Global Impression (CGI-I) between baseline and week 12. Patients that received active tDCS achieved a significant reduction of OCD symptoms than sham, with mean (SD) Y-BOCS score changes of 6.68 (5.83) and 2.84 (6.3) points, respectively (Cohen’s d: 0.62 (0.06–1.18), p = 0.03). We found no between-group differences in responders (four patients in the active tDCS and one in the sham group). Active tDCS of the SMA was not superior to sham in reducing symptoms of depression or anxiety. Patients in both groups reported mild adverse events. Our results suggest that cathodal tDCS over the SMA is an effective add-on strategy in treatment-resistant OCD.

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Fig. 1: CONSORT flow diagram for a study of transcranial direct current stimulation for the treatment of obsessive-compulsive disorder.
Fig. 2: Changes in the Mean Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Score Over Time (tDCS group n = 22, sham tDCS n = 21).

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Acknowledgements

We thank Rosa Rios, BS, Marinês Joaquim, BS, and Ivanil Moraes, BS for administrative support.

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RMFS, RGS, and ARB had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: ARB, MCB, DLCC, JBD, ECM, and RGS. Acquisition, analysis, or interpretation of data: RMFS, ARB, SG, MCB, DLCC, JBD, FP, GDU, ECM, and RGS. Drafting of the paper: RMFS, ARB, SG, MCB, DLCC, JBD, FP, GDU, ECM, and RGS. Critical revision of the paper for important intellectual content: RMFS, ARB, SG, MCB, DLCC, JBD, FP, GDU, ECM, and RGS. Statistical analysis: RMFS, ARB, and SG. Obtained funding: ARB, ECM, RGS. Administrative, technical, or material support: RMFS, ARB, MCB, DLCC, JBD, ECM, and RGS. Supervision: ARB, ECM, and RGS.

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Correspondence to Renata de Melo Felipe da Silva.

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Silva, R.d.M.F.d., Brunoni, A.R., Goerigk, S. et al. Efficacy and safety of transcranial direct current stimulation as an add-on treatment for obsessive-compulsive disorder: a randomized, sham-controlled trial. Neuropsychopharmacol. (2021). https://doi.org/10.1038/s41386-020-00928-w

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