COGNITIVE ENHANCING EFFECT OF RTMS COMBINED WITH TDCS IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER: A DOUBLE-BLIND, RANDOMIZED, SHAM-CONTROLLED STUDY

Abstract Background Cognitive dysfunction is one of the common symptoms in patients with major depressive disorder (MDD). Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have been studied separately in the treatment of cognitive dysfunction in MDD patients. Aims & Objectives We aimed to investigate the effectiveness and safety of rTMS combined with tDCS as a new therapy to improve neurocognitive impairment in MDD patients. Method In this brief two-week, double-blind, randomized, and sham-controlled trial, a total of 550 patients were screened, and 240 MDD inpatients were randomized into four groups (active rTMS + active tDCS, active rTMS +sham tDCS, sham rTMS + active tDCS, sham rTMS +sham tDCS). Finally, 203 patients completed the study and received 10 treatment sessions over a two-week period. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was performed to assess patients’ cognitive function at baseline and week 2. Also, we applied the 24-item Hamilton Depression Rating Scale (HDRS-24) to assess patients’ depressive symptoms at baseline and week 2. Results After 10 sessions of treatment, the rTMS combined with the tDCS group showed more significant improvements in RBANS total score and visuospatial/ constructional index than the other three groups (all p <0.05). However, rTMS or tDCS alone was not superior to the sham group in terms of cognitive performance. In addition, the rTMS combined with tDCS group showed a greater reduction in HDRS-24 total score and a better depression remission rate than the other three groups. Discussion & Conclusion rTMS combined with tDCS treatment is more effective than any single intervention in treating cognitive dysfunction and depressive symptoms in MDD patients. References 1.Miron, J.P., Jodoin, V.D., Lespé rance, P. and Blumberger, D.M., 2021. Repetitive transcranial magnetic stimulation for major depressive disorder: basic principles and future directions. Therapeutic Advances in Psychopharmacology, 11, p.20451253211042696. 2.Martin, D.M., McClintock, S.M., Forster, J. and Loo, C.K., 2016. Does therapeutic repetitive transcranial magnetic stimulation cause cognitive enhancing effects in patients with neuropsychiatric conditions? A systematic review and meta-analysis of randomised controlled trials. Neuropsychology review, 26, pp.295-309. 3.Roth, S., Oyeyemi, A.L., Stoutenberg, M., Gehris, J., Moore, T., Matthew, J. and Baishya, M.L., 2021. Search Strategies for a Systematic Review of Community violence Exposure, Physical Activity and Mental Health. 4.Martin, D.M., Moffa, A., Nikolin, S., Bennabi, D., Brunoni, A.R., Flannery, W., Haffen, E., McClintock, S.M., Moreno, M.L., Padberg, F. and Palm, U., 2018. Cognitive effects of transcranial direct current stimulation treatment in patients with major depressive disorder: an individual patient data meta- analysis of randomised, sham-controlled trials. Neuroscience &Biobehavioral Reviews, 90, pp.137-145. 5.Mutz, J., Vipulananthan, V., Carter, B., Hurlemann, R., Fu, C.H. and Young, A.H., 2019. Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: systematic review and network meta-analysis. bmj, 364. 6.Figeys, M., Zeeman, M. and Kim, E.S., 2021. Effects of transcranial direct current stimulation (tDCS) on cognitive performance and cerebral oxygen hemodynamics: a systematic review. Frontiers in Human Neuroscience, 15, p.623315. 7.Zhang, Z., Zhang, H., Xie, C.M., Zhang, M., Shi, Y., Song, R., Lu, X., Zhang, H., Li, K., Wang, B. and Yang, Y., 2021. Task-related functional magnetic resonance imaging-based neuronavigation for the treatment of depression by individualized repetitive transcranial magnetic stimulation of the visual cortex. Science China Life Sciences, 64, pp.96-106.