RESIDENT: The NESBID Trial: Transcranial Direct Current Stimulation for the Treatment of Ultra Treatment-Resistant Depression

Evaluate the session

Presenting Author(s): Dr. Raheem Suleman

Co-Author(s): Michael L. Demas, Serdar Dursun, Andrew Greenshaw, Olivia Guerra, Robert Mallett, Benjamin Tucker, Michael Wlasichuk

Date and time: 23 Mar 2019 from 14:10 to 14:30

Location: Hawthorn C  Floor Map


  1. Explain the proposed mechanism of action of trans-cranial direct current stimulation in the treatment of depression
  2. Compare and contrast the benefits and disadvantages of trans-cranial direct current stimulation with other neuromodulatory techniques;
  3. Evaluate a proof of concept randomized control trial designed to explore the effectiveness of transcranial direct current stimulation in the treatment of ultra treatment resistant depression

Literature References

  1. Patten, S. B. et al. Descriptive epidemiology of major depressive disorder in Canada in 2012. Can. J. Psychiatry 60, 23–30 (2015).
  2. Ferrari, A. J. et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study
    2010. PLoS Med. 10, e1001547 (2013).
  3. Rizvi, S. J. et al. Treatment-resistant depression in primary care across Canada. Can. J. Psychiatry 59, 349–357 (2014).
  4. Bikson, M. et al. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimulation (2016).


In Canada, the annual prevalence of major depressive episodes is 4.7% 1. Depressive disorders are the second leading cause of
disability worldwide 2. Despite recent advances, more than 1 in 5 Canadians with depression have treatment-resistance and fail to remit
with multiple trials of pharmacologic therapies 3. Transcranial direct current stimulation (tDCS), which uses low amplitude electrical
current to modulate synaptic transmission, is safe, can be delivered in an outpatient setting without need of anaesthesia, and is a
promising treatment option for such individuals 4.

Here, we present the initial results of an ongoing randomized trial examining the effectiveness of tDCS and tDCS enhanced by audiovisual
entrainment (etDCS) as compared to treatment-as-usual in the care of patients with ultra treatment-resistant unipolar or bipolar
depression. Individuals are eligible for inclusion if they have a current score >34 on the Montgomery Asberg Depression Rating Scale
(MADRS), and have failed to remit despite receiving electroconvulsive therapy, ketamine, previous trials with at least five
antidepressants, or with the simultaneous use of two mood stabilizers (for bipolar depression). The intervention consists of 2 mA of
current directed over the left dorsolateral prefrontal cortex for 30 minutes a day, for a total of 30 treatment sessions. The primary
outcome is improvement on the MADRS, with secondary outcomes including improvement on the Quick Inventory of Depressive
Symptomatology - Self Report 16 (QIDS-SR16), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and
an exploratory analysis of patient-reported side-effects.

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