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Treatment of major depressive disorder post stroke with transcranial direct corrent stimulation (TDCS): randomized, double-blind, clinical trial

Grant number: 11/22872-4
Support Opportunities:Regular Research Grants
Duration: September 01, 2012 - August 31, 2014
Field of knowledge:Health Sciences - Medicine - Medical Clinics
Principal Investigator:Alessandra Carvalho Goulart
Grantee:Alessandra Carvalho Goulart
Host Institution: Hospital Universitário (HU). Universidade de São Paulo (USP). São Paulo , SP, Brazil
Associated researchers: Alessandra Fernandes Baccaro ; Andre Russowsky Brunoni ; Leandro da Costa Lane Valiengo


Stroke is one of the main public health problems in America Latina. It is associated with several neuropsychiatric complications, including a broad spectrum of emotional and cognitive impairments. Such disabilities can ultimately result in important clinical implications for the prognosis of these patients. In fact, major depression is a common complication, affecting 5-72% of patients. Post-stroke depression is associated with various cognitive deficits such as deficits in memory, attention and psychomotor speed, and also with increased mortality - up to 50%. Treatment of post-stroke depression is important not only to improve depressive symptoms but also to improve cognitive deficits and, consequently improving activities of daily living and survival in these patients. Different treatments for post-stroke depression have been proposed with diverse results: whereas antidepressants showed efficacy in selected groups, tolerability and treatment adherence were important issues that impaired full treatment efficacy. Therefore, new therapeutic modalities that combine efficacy and tolerability are warranted. In this context, Transcranial direct current stimulation (tDCS) is a novel, non-invasive technique in which a low intensity direct current is applied through the skull. Thus, the DC could be applied over brain MDD-related areas, such as the dorsolateral prefrontal cortex, thereby leading to neuroplasticity and MDD treatment. Indeed, some pilot studies showed that tDCS could ameliorate depressive symptoms. This study proposes to investigate the effect of tDCS for the treatment of major depressive disorder after stroke, being the pioneer controlled study using tDCS for this condition. The proposed design is a randomized, double-blind, placebo-controlled trial in a subsample of participants in the prospective cohort of stroke: EMMA Study (Study of Morbidity and Mortality of stroke). At in this study, 48 patients will be enrolled with post stroke depression, wich they will be randomized to one of two groups: "sham"group (similar to placebo) or active tDCS for ten consecutive days.They return at the end of two weeks to evaluate the improvement in depression severity. Other outcomes will be to verify improvement in cognition and functionality through neuropsychiatries tests and of biomarkers associated with depression. We hope that the results of our study can corroborate to clinical treatment in this group of patients,as well as, contribute to new studies in the field of neuromodulation and neuropsychiatry. (AU)

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Scientific publications (4)
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
VALIENGO, LEANDRO; CASATI, ROBERTA; BOLOGNINI, NADIA; LOTUFO, PAULO A.; BENSENOR, ISABELA M.; GOULART, ALESSANDRA C.; BRUNONI, ANDRE R.. Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients: a case series. NEUROCASE, v. 22, n. 2, p. 225-228, . (12/20911-5, 11/22872-4)
GOULART, ALESSANDRA CARVALHO. ``EMMA Study: a Brazilian community-based cohort study of stroke mortality and morbidity{''}. São Paulo Medical Journal, v. 134, n. 6, p. 543-554, . (10/20562-5, 15/17321-0, 11/22872-4, 11/17568-4)
VALIENGO, LEANDRO C. L.; GOULART, ALESSANDRA C.; DE OLIVEIRA, JANAINA F.; BENSENOR, ISABELA M.; LOTUFO, PAULO A.; BRUNONI, ANDRE R.. Transcranial direct current stimulation for the treatment of post-stroke depression: results from a randomised, sham-controlled, double-blinded trial. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, v. 88, n. 2, p. 170-175, . (12/20911-5, 11/22872-4)

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