Comparing the Effects of CBT Plus tDCS or Pharmacotherapy on Depressive Symptoms, Inhibition, and Cognitive Flexibility in Stroke Patients: A Randomized Clinical Trial

Objectives The present study aims to compare the effects of cognitive-behavioral therapy (CBT) plus transcranial direct current stimulation (tDCS) or pharmacotherapy on depression symptoms, inhibition and cognitive flexibility of stroke patients Methods This is a randomized controlled clinical trial with a pre-test/post-test/follow-up design. The study population consists of all stroke sufferers referred to Dr. Hashemzehi's clinic in Zahedan, south of Iran, in 2022. The samples were 45 eligible patients who were selected by a convenience sampling method and randomly divided into three groups of 15 including CBT+tDCS, CBT+pharmacotherapy, and control. To measure depression, inhibition, and cognitive flexibility, we used Beck’s depression inventory, go/no go test, and Stroop test in the pre-test, post-test, and 2-month follow-up phases. The CBT was provided at 12 sessions according to Kootker et al.'s CBT protocol for stroke patients. The tDCS program was 20 sessions of anodal stimulation over the left dorsolateral prefrontal cortex. The pharmacotherapy was the administration of 10 mg citalopram daily for three weeks. Results The results indicated the short-term and long-term effectiveness of both CBT+tDCS and CBT + pharmacotherapy in reducing depression symptoms (P<0.05), and there was no significant difference between their effectiveness of . Only the CBT+tDCS had a short-term effect on improving inhibition and cognitive flexibility. Conclusion Both CBT+tDCS and CBT+pharmacotherapy (10 mg citalopram) can be useful for reducing depression symptoms in stroke sufferers.