Nesta página reunimos estudos, publicações científicas, materiais de divulgação e outros conteúdos relacionados com o projeto 4MUMS e com a investigação sobre estimulação cerebral não invasiva, saúde mental perinatal e tratamentos digitais.
https://doi.org/10.1038/s41598-026-35443-3
Abstract
Peripartum depression (PPD) has a global prevalence of 20% significantly impacting societies. Yet, existing treatments face barriers for its uptake. This study examined the acceptability of a remotely supervised home-based transcranial direct current stimulation (tDCS) solution combined with a CBT-based app (the FLOW Neuroscience solution) for PPD, among women (experts by experience; EEs) and healthcare professionals (HPs). Fifteen EEs and 14 HPs participated in focus groups informed by the Theoretical Framework of Acceptability. Narratives were iteratively refined, using the template analysis method. Participants were overall positive about the treatment considering it supports patients’ autonomy, freedom of choice and a universally accessible perinatal mental health care system. However, they also highlighted several concerns, such as the limitations of exclusively remote/virtual and bot-lead interventions which, on the one hand, may address fear of stigma about perinatal mental health, but on the other may also increase loneliness in depressed patients. Additionally, participants emphasized the need for effective communication strategies to build trust over health innovation and recommended the integration of home-based remotely supervised tDCS treatments combined with a CBT-based app into existing care models. Our findings suggest that while the FLOW solution addresses existing gaps in PPD it also presents some limitations. Here we provide user-centered actionable insights into the adjustment of this innovative, home-based solution to enhance access and engagement in PPD care.
https://journals.lww.com/co-psychiatry/abstract/2024/09000/transcranial_magnetic_stimulation_and_transcranial.3.aspx
Abstract
Purpose of review
To present the latest data on the efficacy, safety, and acceptability of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in peripartum depression (PPD), complemented by notes emerging from our clinical and research experience.
Recent findings
TMS and tDCS show promising results to manage mild to moderate depressive symptoms in the peripartum period. Evidence of TMS efficacy during pregnancy and the postpartum comes from two small randomized controlled trials (RCTs) with encouraging but still inconsistent results. Evidence of tDCS efficacy during pregnancy comes from one small RCT and in the postpartum the first RCT is just now being conducted and results are highly expected. The safety profile (with transient mild adverse effect to women and no known risk to the foetus/newborn) and acceptability by women seems overall good. However, the perspectives from health professionals and managers are unclear.
Summary
Whereas TMS accelerated protocols (e.g., more than one session/day) and shorter sessions (e.g., theta burst stimulation) could address the need for fast results in PPD, home-based tDCS systems could address accessibility issues. Currently, the evidence on the efficacy of TMS and tDCS in PPD is limited warranting further research to support stronger evidence-based clinical guidelines.
https://doi.org/10.1016/j.cnp.2026.03.006
Abstract
Transcranial direct current stimulation (tDCS) is a potential treatment strategy across some psychiatric conditions. However, there is high heterogeneity in tDCS efficacy as a stand-alone treatment. To increase its therapeutic potential, researchers have begun to explore the efficacy of combining tDCS with psychological and pharmacological interventions. The current case series details the effect of 6–10 weeks of self-administered tDCS paired with a behavioral therapy smartphone app (Flow™), on depressive and anxiety symptoms, in seven patients (26–51 years old; four female) presenting distinctive psychiatric disorders (major depression, dysthymia, illness anxiety disorder, obsessive-compulsive disorder, and anxiety disorders). tDCS protocol consisted of an acute phase of daily 30 min sessions, across 10 workdays (2 weeks Monday-to-Friday; Protocol 1) or 15 workdays (3 weeks Monday-to-Friday; Protocol 2). A maintenance phase followed, with twice-weekly sessions for 4 or 3 weeks, corresponding to 18 or 21 sessions in total (Protocol 1 or 2, respectively). The Flow tDCS device uses a 2 mA current intensity, targeting the bilateral dorsolateral prefrontal cortex. The Flow app offers virtually guided behavioral therapy courses to be completed during stimulation. We assessed depressive symptoms using MADRS-S and BDI-II, anxious symptoms using STAI-Trait, acceptability using ACCEPT-tDCS, and side effects using the Adverse Effects Questionnaire, at baseline and week 6 of treatment. Six patients underwent simultaneous cognitive-behavioral psychotherapy and two were on antidepressants and benzodiazepines. According to the Reliable Change Index (RCI), for depressive symptoms, we found clinically reliable improvement in five patients using MADRS-S (out of seven; RCI: −1.45, 80% CI; RCI: −2.17 to −4.82, 95% CI; percentage change: 37.9–66.7%) and in four patients using BDI-II (out of five; RCI: −3.61 to −6.70, 95% CI; percentage change: 57.1–100%). For anxiety symptoms, clinically reliable improvement was observed in five patients (out of six; RCI: −1.79, 90% CI; RCI: −2.55 to −8.64, 95% CI; percentage change: 12.3–46.4%). Stimulation was well-tolerated and accepted, with mild tingling sensation and scalp discomfort being the most common side effects. This case series highlights the applicability, acceptability, and promising results when combining home-based tDCS with psychotherapy and pharmacotherapy to manage depression and anxiety symptoms in clinical practice.
https://www.scirp.org/journal/paperinformation?paperid=133827
Abstract
Background: Flow FL-100 is a transcranial direct current stimulation (tDCS) device designed to alleviate symptoms of depression, offering an alternative to psychotherapy and pharmacological interventions. The Flow treatment also includes access to wellbeing behaviour therapy training delivered through a software application. This study examines the user experience and perceived value of Flow among individuals receiving care from a Specialist Perinatal Mental Health Service and the Maternal Loss Psychology Service. Methods: Qualitative methods, including semi-structured interviews, were employed to explore participants’ experience over a six-week period. Interpretative Phenomenological Analysis (IPA) was utilised to analyse the data. The study recruited thirteen female participants aged between 29 and 40 all diagnosed with depression, with five having experienced maternal loss and eight reporting postpartum depression. Results: Participants reported positive experiences with Flow, highlighting its user-friendly interface, accessibility, and the availability of visual instructions. Most participants adhered to the treatment protocol, but challenges such as life-style restrictions were noted. Participants appreciated a non-medication treatment alternative and reported improvements in depressive symptoms, mood, sleep quality, and overall well-being. Discussion: The findings underscore the potential of Flow as a non-pharmacological intervention for depression. Individual variability in treatment response and engagement with the app’s training emphasise the need for personalised approaches. Further research is warranted to explore the long-term experience and value of Flow treatment.
https://doi.org/10.1016/j.brs.2019.06.019
Abstract
Background: Depression in pregnancy negatively affects maternal-child health. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation treatment for depression, has not been evaluated in pregnancy.
Objective: To conduct a pilot randomized controlled trial (RCT) to evaluate tDCS for antenatal depression.
Methods: In this pilot RCT in Toronto, Ontario (October 2014 to December 2016), adult pregnant women 14-32 weeks gestation with major depressive disorder who had declined antidepressant medication were considered for inclusion. Participants were randomly assigned 1:1 to tDCS or sham-control. Active tDCS comprised 30-min sessions of 2 mAmp direct current delivered over the dorsolateral prefrontal cortex, 5 days per week, for 3 weeks. Sham was administered similarly, but with current turned off after 30 s. Main outcomes were feasibility, acceptability, and protocol adherence. Maternal Montgomery Asperg Depression Rating Scale (MADRS) was measured post-treatment and at 4 and 12 weeks postpartum.
Results: Of 20 women randomized, 16 completed treatment and provided data (124 tDCS, 122 sham sessions). Views of treatment were positive with no serious adverse events. Post-treatment estimated marginal mean MADRS scores were 11.8 (standard error, SE 2.66) for tDCS and 15.4 (SE 2.51) for sham (p = 0.34). At 4 weeks postpartum, 75.0% of tDCS women were remitted versus 12.5% sham-control (p = 0.04).
Conclusions: Results support proceeding to a definitive RCT to evaluate tDCS for antenatal depression. The preliminary efficacy estimates immediately post-treatment and in the postpartum, are encouraging with respect to the potential use of tDCS to improve treatment rates in this population. The trial was registered at: clinical trials.gov (NCT02116127).
Keywords: Antenatal depression; Antidepressive agents; Brain stimulation; Pregnancy; Transcranial direct current stimulation; tDCS.
https://rdcu.be/fj0O1
Abstract
Transcranial direct current stimulation (tDCS) has been proposed as a new treatment in major depressive disorder (MDD). This is a fully remote, multisite, double-blind, placebo-controlled, randomized superiority trial of 10-week home-based tDCS in MDD. Participants were 18 years or older, with MDD in current depressive episode of at least moderate severity as measured using the Hamilton Depression Rating Scale (mean = 19.07 ± 2.73). A total of 174 participants (120 women, 54 men) were randomized to active (n = 87, mean age = 37.09 ± 11.14 years) or sham (n = 87, mean age = 38.32 ± 10.92 years) treatment. tDCS consisted of five sessions per week for 3 weeks then three sessions per week for 7 weeks in a 10-week trial, followed by a 10-week open-label phase. Each session lasted 30 min; the anode was placed over the left dorsolateral prefrontal cortex and the cathode over the right dorsolateral prefrontal cortex (active tDCS 2 mA and sham tDCS 0 mA, with brief ramp up and down to mimic active stimulation). As the primary outcome, depressive symptoms showed significant improvement when measured using the Hamilton Depression Rating Scale: active 9.41 ± 6.25 point improvement (10-week mean = 9.58 ± 6.02) and sham 7.14 ± 6.10 point improvement (10-week mean = 11.66 ± 5.96) (95% confidence interval = 0.51–4.01, P = 0.012). There were no differences in discontinuation rates. In summary, a 10-week home-based tDCS treatment with remote supervision in MDD showed high efficacy, acceptability and safety. ClinicalTrials.gov registration: NCT05202119
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2813623
Abstract
Importance: Transcranial direct current stimulation (tDCS) is moderately effective for depression when applied by trained staff. It is not known whether self-applied tDCS, combined or not with a digital psychological intervention, is also effective.
Objective: To determine whether fully unsupervised home-use tDCS, combined with a digital psychological intervention or digital placebo, is effective for a major depressive episode.
Design, setting, and participants: This was a double-blinded, sham-controlled, randomized clinical trial with 3 arms: (1) home-use tDCS plus a digital psychological intervention (double active); (2) home-use tDCS plus digital placebo (tDCS only), and (3) sham home-use tDCS plus digital placebo (double sham). The study was conducted between April 2021 and October 2022 at participants' homes and at Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. Included participants were aged 18 to 59 years with major depression and a Hamilton Depression Rating Scale, 17-item version (HDRS-17), score above 16, a minimum of 8 years of education, and access to a smartphone and internet at home. Exclusion criteria were other psychiatric disorders, except for anxiety; neurologic or clinical disorders; and tDCS contraindications.
Interventions: tDCS was administered in 2-mA, 30-minute prefrontal sessions for 15 consecutive weekdays (1-mA, 90-second duration for sham) and twice-weekly sessions for 3 weeks. The digital intervention consisted of 46 sessions based on behavioral therapy. Digital placebo was internet browsing.
Main outcomes and measures: Change in HDRS-17 score at week 6.
Results: Of 837 volunteers screened, 210 participants were enrolled (180 [86%] female; mean [SD] age, 38.9 [9.3] years) and allocated to double active (n = 64), tDCS only (n = 73), or double sham (n = 73). Of the 210 participants enrolled, 199 finished the trial. Linear mixed-effects models did not reveal statistically significant group differences in treatment by time interactions for HDRS-17 scores, and the estimated effect sizes between groups were as follows: double active vs tDCS only (Cohen d, 0.05; 95% CI, -0.48 to 0.58; P = .86), double active vs double sham (Cohen d, -0.20; 95% CI, -0.73 to 0.34; P = .47), and tDCS only vs double sham (Cohen d, -0.25; 95% CI, -0.76 to 0.27; P = .35). Skin redness and heat or burning sensations were more frequent in the double active and tDCS only groups. One nonfatal suicide attempt occurred in the tDCS only group.
Conclusions and relevance: Unsupervised home-use tDCS combined with a digital psychological intervention or digital placebo was not found to be superior to sham for treatment of a major depressive episode in this trial.
Trial registration: ClinicalTrials.gov Identifier: NCT04889976.