THE COMBINATION of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) provides significantly better outcomes in the treatment of major depressive disorder (MDD) than either therapy alone.
This double-blind, randomised clinical trial evaluated the effectiveness and safety of combining tDCS and rTMS in treating MDD, a condition where novel non-invasive treatments are increasingly explored. Conducted at three hospitals in China between November 2021 and April 2023, the study enrolled 240 adult participants aged 18–65 years. Participants were randomly assigned to one of four groups: active tDCS combined with active rTMS, sham tDCS with active rTMS, active tDCS with sham rTMS, or sham tDCS with sham rTMS. The primary aim was to assess symptom reduction as measured by the Hamilton Depression Rating Scale (HDRS-24).
Over a two-week period, participants received tDCS and rTMS sessions targeting the dorsolateral prefrontal cortex. The active combination therapy group demonstrated the largest mean reduction in HDRS-24 scores (18.33), compared with the sham tDCS + active rTMS group (14.86), active tDCS + sham rTMS group (9.21), and sham tDCS + sham rTMS group (10.77). Statistical analysis confirmed these differences were significant (F3,236 = 35.79; η² = 0.31; P < .001), indicating a substantial effect size. Additionally, the safety profile of the combination therapy was comparable to the individual interventions, with no serious adverse events reported.
These findings suggest that combining tDCS and rTMS enhances therapeutic efficacy in treating MDD, likely due to their complementary mechanisms of action on prefrontal cortical activity. Given the manageable safety profile, this combined approach holds promise for clinical practice. Future research should explore optimal protocols, long-term outcomes, and patient-specific factors influencing response. Incorporating this dual-modality treatment could improve outcomes for patients who have not benefited from conventional therapies.
Reference
Zhou D et al. Transcranial direct current stimulation combined with repetitive transcranial magnetic stimulation for depression: a randomized clinical trial. JAMA Netw Open. 2024;7(11):e2444306.
