Evidence map›Paper›PMID 31039579›Full record

Trial reportNeuropsychopharmacology : official publication of the American College of Neuropsychopharmacology2019

Neural predictors of treatment response to brain stimulation and psychological therapy in depression: a double-blind randomized controlled trial.

Camilla L Nord, D Chamith Halahakoon, Tarun Limbachya, Caroline Charpentier, Níall Lally, Vincent Walsh, Judy Leibowitz, Stephen Pilling, Jonathan P Roiser

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
37citing papers in PubMed, 11 pooled it
6.5field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

37 citing papers in PubMed, 11 syntheses or guidelines pooled it, 84 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 6 institutions in 2 countries.

Camilla L NordInstitute of Cognitive Neuroscience, University College London, London, UK. Camilla.Nord@mrc-cbu.cam.ac.uk.ORCID http://orcid.org/0000-0002-9281-3417
D Chamith HalahakoonInstitute of Cognitive Neuroscience, University College London, London, UK.
Tarun LimbachyaCamden and Islington NHS Foundation Trust, London, UK.
Caroline CharpentierInstitute of Cognitive Neuroscience, University College London, London, UK.
Níall LallyInstitute of Cognitive Neuroscience, University College London, London, UK.
Vincent WalshInstitute of Cognitive Neuroscience, University College London, London, UK.
Judy LeibowitzCamden and Islington NHS Foundation Trust, London, UK.
Stephen PillingCamden and Islington NHS Foundation Trust, London, UK.
Jonathan P RoiserInstitute of Cognitive Neuroscience, University College London, London, UK.ORCID http://orcid.org/0000-0001-8269-1228
University College London · GBCamden and Islington NHS Foundation Trust · GBCalifornia Institute of Technology · USMRC Cognition and Brain Sciences Unit · GBNational Institutes of Health · USUniversity of Oxford · GB

Funding

Brain and Behavior Research Foundation (Brain & Behavior Research Foundation) 20162Medical Research Council MC_U105579215
6 · The paper itself

Abstract

Standard depression treatments, including antidepressant medication and cognitive behavioural therapy (CBT), are ineffective for many patients. Prefrontal transcranial direct current stimulation (tDCS) has been proposed as an alternative treatment, but has shown inconsistent efficacy for depression, and its mechanisms are poorly understood. We recruited unmedicated patients with major depressive disorder (N = 71 approached; N = 39 randomised) for a mechanistic, double-blind, randomized controlled trial consisting of eight weekly sessions of prefrontal tDCS administered to the left prefrontal cortex prior to CBT. We probed (1) whether tDCS improved the efficacy of CBT relative to sham stimulation; and (2) whether neural measures predicted clinical response. We found a modest and non-significant effect of tDCS on clinical outcome over and above CBT (active: 50%; sham: 31.6%; odds ratio: 2.16, 95% CI = 0.59-7.99), but a strong relationship, predicted a priori, between baseline activation during a working memory task in the stimulated prefrontal region and symptom improvement. Repeating our analyses of symptom outcome splitting the sample according to this biomarker revealed that tDCS was significantly superior to sham in individuals with high left prefrontal cortex activation at baseline; we also show 86% accuracy in predicting clinical response using this measure. Exploratory analyses revealed several other regions where activation at baseline was associated with subsequent response to CBT, irrespective of tDCS. This mechanistic trial revealed variable, but predictable, clinical effects of prefrontal tDCS combined with CBT for depression. We have discovered a potential explanation for this variability: individual differences in baseline activation of the region stimulated. Such a biomarker could potentially be used to pre-select patients for trials and, eventually, in the clinic.

Indexed as

AdultBrainCognitive Behavioral TherapyCombined Modality TherapyDouble-Blind MethodFemaleFunctional NeuroimagingHumansMagnetic Resonance ImagingMajor Depressive DisorderMaleMiddle AgedPrefrontal CortexPrognosisTranscranial Direct Current StimulationYoung Adult

Identifiers

PMID31039579
PMCPMC6784995
OpenAlexW2942668506

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.