Post-stroke depression (PSD) is a serious complication that can undercut a patient’s rehab progress and quality of life. Doctors often prescribe anti-depressants to treat it, especially selective serotonin reuptake inhibitors (SSRIs). SSRIs like Prozac and Paxil are popular, but not always effective. They also have possible side effects that can be dangerous for stroke survivors.
Fortunately, scientists are devising and evaluating alternative treatments all the time. For instance, Italian researchers recently reviewed the available studies on treating PSD with Non-Invasive Brain Stimulation (NIBS). NIBS techniques use electricity or magnetism to stimulate or dampen brain activity. Researchers included studies that used either Repetitive Transcranial Magnetic Stimulation (rTMS) or Transcranial Direct-Current Stimulation (tDCS). The news is promising but not yet conclusive. The team found evidence that these treatments can be helpful for PSD. But, they also found that far more research needs to be done to systematize appropriate settings and treatment regimens.
rTMS is a therapy that applies magnetic fields to the brain from outside the head. The treatment is non-invasive and has relatively few side effects. A trained technician uses an appliance held near the patient’s head to direct the desired type of magnetic field to the appropriate part of the brain.
The FDA has only officially approved rTMS as a treatment for medication-resistant severe anxiety and depression, not PSD. Using rTMS for PSD is an “off-label” application that is legal but may not be covered by your insurance. Without insurance rTMS costs between $100 and $200 per session. Also, many facilities sell their treatments in blocks of 36 sessions because the FDA recommends that many to treat depression. This number of treatments is much higher than what is typically studied for stroke patients. The studies reviewed here, for example, provided ten sessions.
tDCS is an emerging technology that uses direct current between two electrodes attached to the head to either stimulate or dampen brain activity. Researchers studied this as a therapy for several conditions including depression, but the FDA has not approved it. However, tDCS is non-invasive, inexpensive, and safe when used according to directions. tDCS units are available commercially from $150 to $600 and can be used at home. That said, you should consult with your therapy team before beginning or buying tDCS equipment or any other treatment.
Watch this video to learn more about tDCS
Researchers at the University of Trento looked for articles focusing on treating PSD with either rTMS or tDCS. They found four articles that met their criteria. One focused on tDCS and three focused on rTMS. Altogether the studies followed 157 patients between the ages of 38 and 57, and all treatments targeted a region in the front of the brain that is responsible for memory and thinking skills.
These studies indicate that both rTMS and tDCS can help alleviate PSD. The researchers speculate that rTMS may be more appropriate for severe depression and that tDCS may be more appropriate for milder cases. Unfortunately, the existing research into this topic has some significant shortcomings. The studies all used different measurements of effectiveness and none of them followed up with patients over longer time-frames. Also, none of these studies concerned themselves with best practices or even appropriate settings for the equipment.
So while the results are cause for optimism, a lot of work remains. However, it is worth discussing these treatments with your doctor as a possible alternative to medication.
The lead author of the original review was Madalina Bucur, the Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy.