Cognitive outcomes of the bipolar depression electrical treatment trial (BETTER): a randomized, double-blind, sham-controlled study

European Archives of Psychiatry and Clinical Neuroscience volume 271, pages93–100(2021)Cite this article

Abstract

Bipolar depression is associated with marked cognitive deficits. Pharmacological treatments for this condition are limited and may aggravate depressive and cognitive symptoms. Therefore, therapeutic interventions that preserve adequate cognitive functioning are necessary. Our previous results demonstrated significant clinical efficacy of transcranial direct current stimulation (tDCS) in the Bipolar Depression Electrical Treatment Trial (BETTER). Here, cognitive outcomes of this study are reported. We randomized 59 patients with bipolar disorder I or II in an acute depressive episode to receive active (12 2 mA, 30-min, anodal-left, cathodal-right prefrontal cortex tDCS sessions) or sham tDCS. Patients were on stable pharmacological regimen for at least 2 weeks. A battery of 12 neuropsychological assessments in five cognitive domains (attention and processing speed, memory, language, inhibitory control, and working memory and executive function) was performed at baseline, after two weeks and at endpoint (week 6). No significant differences between groups over 6 weeks of treatment were observed for any cognitive outcomes. Moreover, no decrease in cognitive performance was observed. Our findings warrant further replication in larger studies. Trial Registration: clinicaltrials.gov Identifier: NCT02152878

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Acknowledgements

This study was directly supported by a Young Investigator Grant from the Brain and Behavior Research Foundation (NARSAD, Grant no. 13/20493). NARSAD had no role in the collection, management, analysis, and interpretation of the data; and also no role in the preparation, review, or approval of the manuscript. ARB received grants from the 2012 Young Research Award from the São Paulo State Foundation (Grant no. 20911-5), the National Council for Scientific and Technological Development (CNPQ, PQ-1B, to Dr. Brunoni), the Program of Academic Productivity (PIPA) of the University of São Paulo Medical School (to Dr. Brunoni), and by the Associação Beneficente Alzira Denise Hertzog da Silva (to the LIM27 neuroscience laboratory). The current analyses were support by a doctoral academic excellence grant from CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior).The authors are grateful to Cibele Soares, Lais Razza, Renan Chamorro, Luara Tort and Rosa Rios, who were of invaluable help in executing the study.

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Affiliations

  1. Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo and Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, São Paulo, 05508-000, Brazil

    Gabriel Tortella, Paulo Andrade Lotufo, Isabela M. Benseñor & Andre R. Brunoni

  2. Private Practice, São Paulo, Brazil

    Gabriel Tortella, Bernardo Sampaio-Junior, Marina L. Moreno & Adriano Fernandes da Silva

  3. School of Psychiatry, Black Dog Institute, University of New South Wales, Hospital Rd, Randwick, Sydney, NSW, 2031, Australia

    Adriano H. Moffa

  4. Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil

    Beny Lafer

  5. Service of Interdisciplinary Neuromodulation, Instituto de Psiquiatria, Laboratory of Neurosciences (LIM-27)Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, R Dr Ovidio Pires de Campos 785, 2o andar, São Paulo, 05403-000, Brazil

    Wagner Gattaz, Lucas Borrione & Andre R. Brunoni

  6. Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Science Center, Houston, TX, USA

    Rodrigo Machado-Vieira

  7. Department of Psychological Methodological and Assessment, Ludwig-Maximilians-University, Munich, Germany

    Stephan Goerigk

  8. Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, 80336, Munich, Germany

    Stephan Goerigk

  9. Hochschule Fresenius, University of Applied Sciences, Munich, Germany

    Stephan Goerigk

Authors
  1. Gabriel Tortella
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  2. Bernardo Sampaio-Junior
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  3. Marina L. Moreno
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  4. Adriano H. Moffa
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  5. Adriano Fernandes da Silva
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  6. Beny Lafer
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  7. Paulo Andrade Lotufo
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  8. Wagner Gattaz
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  9. Lucas Borrione
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  10. Rodrigo Machado-Vieira
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  11. Stephan Goerigk
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  12. Isabela M. Benseñor
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  13. Andre R. Brunoni
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Corresponding author

Correspondence to Andre R. Brunoni.

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Communicated by Sebastian Walther.

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Tortella, G., Sampaio-Junior, B., Moreno, M.L. et al. Cognitive outcomes of the bipolar depression electrical treatment trial (BETTER): a randomized, double-blind, sham-controlled study. Eur Arch Psychiatry Clin Neurosci 271, 93–100 (2021). https://doi.org/10.1007/s00406-020-01121-2

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Keywords

  • Transcranial direct current stimulation
  • Bipolar disorder
  • Clinical trial
  • Non-invasive brain stimulation
  • Psychiatry
  • Mental illness