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. 2022 Nov 21:28:100566.
doi: 10.1016/j.bbih.2022.100566. eCollection 2023 Mar.

Transcranial direct-current stimulation over the motor cortex in patients suffering from anxiety and depression related to rheumatoid arthritis: Study protocol for a randomized, double-blind, placebo-controlled trial

Affiliations

Transcranial direct-current stimulation over the motor cortex in patients suffering from anxiety and depression related to rheumatoid arthritis: Study protocol for a randomized, double-blind, placebo-controlled trial

Márcia de Lorena Serra Maia et al. Brain Behav Immun Health. .

Abstract

Rheumatoid arthritis is up to three times more prevalent in women. It is often associated with anxiety and depression, comorbidities causing psychic suffering and potentiating pain perception. It is also related to a higher risk of suicide among diagnosed patients. The high rates of discontinuation of conventional pharmacological treatments are the predominant factor in the search for new therapeutic approaches for the treatment of anxiety and depression. Transcranial direct-current stimulation (tDCS) is a promising, safe and low-cost technique that is very associative with other therapies. When applied to the primary motor cortex (M1) it can induce long-term changes in the synaptic level leading to the improvement of neuroplasticity. The primary aim of this study is to evaluate the effect of tDCS on the symptoms of anxiety and depression. The secondary aim is to evaluate the interference of tDCS on the inflammatory profile, cardiac autonomic behavior and quality of life of patients with rheumatoid arthritis. This is a randomized, double-blind, placebo-controlled clinical trial. The intervention consists of 10 consecutive sessions (once a day) applying tDCS with a 2mA current for 20 minutes. The electrode assembly on the scalp is in accordance with the International Electroencephalogram System 10-20 (EEG) and the anodal electrode is placed over the area of the primary motor cortex (M1 - C3 or C4) and the cathodal electrode on the supraorbital contralateral area (SO - Fp1 or Fp2). The analysis of continuous variables will be described by mean and standard deviation for parametric data and median and interquartile interval for nonparametric data. The evaluation of the effect of tDCS on the inflammatory profile, heart rate variability and quality of life will be obtained by the ANOVA two-way test. tDCS is expected to have a greater effect on reducing anxiety and depression symptoms compared to the placebo, being able to decrease inflammation and improve the quality of life of volunteers.

Keywords: Anxiety; Depression; Inflammation; Neurostimulation; Rheumatoid arthritis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Overview of the study. Assessments before and after intervention are the same for both Intervention group and Placebo group.
Fig. 2
Fig. 2
Electrode montage. Cortical areas stimulated according to 10–20 EEG system depend on the side of the body volunteers report major pain perception – anodal on C3 and cathodal on Fp2 if major pain perceived in the right side and anodal on C4 and cathodal on Fp1 if major pain perceived in the left side. Created with BioRender.com.
Fig. 3
Fig. 3
The extended relationship between mental illness and inflammatory diseases. a. Stress, anxiety and depression; b. Inflammation has a major role in anxiety and depression; c. Inflammation is the source of chronic pain in RA; d. Lack of positive prognosis in RA causes high symptoms of anxiety; e. anxiety and depression enhance the perceived pain; RA causes depression and depression is a risk factor for RA. Created with BioRender.com.
Fig. 4
Fig. 4
The HPA Axis. A dynamic system highly influenced by environmental stimuli, especially affective relationships and self-expectations causing immunological response in order to restore the emotional and physiological balance. Created with BioRender.com.

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