Neue Hirnstimulationsverfahren in der Psychiatrie

Zusammenfassung

Ziel

Die transkranielle Gleichstromstimulation (tDCS) wird in der Behandlung von Depressionen seit einigen Jahren intensiv erforscht. Es soll untersucht werden, welche Schlüsse die Studienlage über den klinischen Einsatz der tDCS in der Behandlung der Depression zulässt.

Material und Methoden

Randomisierte placebokontrollierte klinische Studien, offene Studien, Fallberichte und Übersichtsarbeiten, sämtlich aus der englischsprachigen Fachliteratur, wurden in einer systematischen und umfangreichen Literaturrecherche ausgewertet. Die Übersichtarbeiten wurden hinsichtlich ihrer klinischen Relevanz gewertet.

Ergebnisse

Die Datenlage präsentiert sich uneinheitlich aufgrund des heterogenen Patientenkollektivs und der teilweise hohen Therapieresistenz in einigen Studien, die eine allgemeine Aussage über die Wirksamkeit der tDCS bei Depressionen nicht zuverlässig ermöglichen.

Schlussfolgerung

Die tDCS gilt als sicher und mit nur geringen Nebenwirkungen behaftet. Die Wirksamkeit der tDCS sinkt mit steigender Therapieresistenz. Psychotrope Medikamente können ihre Wirkung abschwächen oder verstärken. Eine Stimulation mit 2 mA Stromstärke über 20 Minuten Dauer pro Tag über einen begrenzten Zeitraum kann als sicher gelten.

Summary

Objective

Transcranial Direct Current Stimulation (tDCS) has been investigated for the treatment of major depressive disorders in recent years. Here, we review the implications of current research for the clinical use of tDCS in the treatment of major depressive disorder.

Materials and methods

Randomized, placebo-controlled clinical trials, openlabel trials, case reports and review articles from English-spoken journals were examined in an extensive and systematic literature search. The review articles were evaluated with regard to their clinical relevance.

Results

Data of the review articles is inconsistent due to the heterogeneous patient samples and the partially high treatment resistance in some studies. A general statement about the efficacy of tDCS as a therapeutic tool in major depression seems not possible yet.

Conclusions

tDCS is considered as a safe therapeutic option and is associated with only minor side effects. The effectiveness of tDCS decreases with resistance to treatment. Psychotropic drugs may attenuate or amplify its effects. The use of 2 mA current strength over 20 minutes per day over a short time span can be considered as safe.

Schlüsselwörter

Nicht invasive Hirnstimulation - tDCS - Depression

Keywords

Non-invasive brain stimulation - tDCS - major depressive disorder

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