PMC:7530274 / 2776-8360 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7530274","sourcedb":"PMC","sourceid":"7530274","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7530274","text":"Tdcs and Stress: Treatment and Prevention of Related Symptoms\nThere is growing interest and studies investigating the effects of tDCS in animal models of stress and humans with chronic and acute stress. Animal models have shown reversal (Adachi et al., 2012) and prevention (Fregni et al., 2018) of chronic-stress induced pain after tDCS. In addition, tDCS was also able to decrease anxiety-like behaviors in rats submitted to neuropathic pain as a chronic stressor model (Marques Filho et al., 2016).\nInteresting results in physiological surrogates of stress, namely heart rate variability (HRV) and salivary cortisol levels after tDCS treatment have been reported. Brunoni et al. (2013) showed that a single session of 1.5 mA anodal tDCS for 3 min targeting the left dorsolateral prefrontal cortex (DLPFC) led to an increase in high-frequency-HRV (HF-HRV) (Cohen's d = 0.77) and a decrease in salivary cortisol level (Cohen's d = 0.78) when compared to sham or cathodal stimulation in healthy individuals, reflecting effects in the autonomic nervous system and the hypothalamic pituitary adrenal (HPA) axis. An increase in parasympathetic and a decrease in sympathetic activity was also demonstrated in athletes by Montenegro et al. (2011) after 2.0 mA anodal stimulation for 20 min targeting the left temporal lobe, with an overall increase in HF-HRV compared to baseline measures (Cohen's d = 0.68).\nDirect effects of tDCS on stress symptoms have also been recently published. Individuals such as healthcare workers, which are usually suffering from high levels of stress and even burnout, could benefit from preventive measures. When 1.075 mA tDCS stimulation of the right DLPFC was performed for 6–10 min in healthy individuals exposed to acute stress, there was less impairment of the working memory compared to sham or cathodal stimulation (Cohen's d = 0.62), showing the potential for the prevention of stress-induced mental disorders (Bogdanov and Schwabe, 2016).\nOn the other hand, patients who already developed psychiatric symptoms related to stress can also benefit from non-invasive brain stimulation. Anodal left DLPFC 1.0 mA tDCS has been shown as well to enhance the working memory when applied for 20 min once a week for 5 weeks in patients with the diagnosis of PTSD undergoing cognitive training programs compared to baseline, although the effects varied between subjects and were dependent on the performance test (Saunders et al., 2015). Another study demonstrated improved extinction-related processes in veterans with warzone-related PTSD when 2.0 mA anodal stimulation for 10 min was combined with fear-extinction therapy. tDCS targeted at the left ventromedial prefrontal cortex (vmPFC) during extinction-consolidation led to lower skin conductance reactivity compared to tDCS applied during extinction-learning (Cohen's d = 0.38) (Van't Wout et al., 2017).\nThe DLPFC has been the usual cortical target for tDCS to prevent and ameliorate the consequences of psychosocial stress (Figure 1). Carnevali et al. (2020) recently postulated that the effects of tDCS may involve both a cognitive control of stress and the autonomic system, involving predominantly parasympathetic (vagal) responses (Carnevali et al., 2020). Further research is needed, however, to determine whether tDCS could prevent the consequences of repeated or persistent exposure to stressful situations such as in the context of social isolation during a pandemic. In addition, the response to anodal 1.0 mA left DLPFC stimulation for 30 min can differ depending on individual anxiety traits (Sarkar et al., 2014), with individuals with high anxiety profiles improving performance in cognitive tests (Cohen's d = 0.82), as well as decreased cortisol levels (Cohen's d = 1.37) compared to sham stimulation, an effect that was not observed in subjects with low anxiety profiles. Therefore, assessing specific psychological traits at baseline could help determine which individuals would benefit more from the effects of tDCS.\nFigure 1 Home-based tDCS over the left DLPFC promoting the cognitive control of Stress, changes in the HPA axis and Parasympathetic/Sympathetic modulation. Created with BioRender.com. Regarding emotional and affective states, tDCS has been well-studied for the treatment of patients with Major Depression, with improvement in depression scores and response rates supported by recent meta-analyses (Cohen's d = 0.74; Odds Ratio 2.44) (Brunoni et al., 2016) and (Hedge's g = 0.37; Odds Ratio 1.63) (Shiozawa et al., 2014). In heathy, non-depressed individuals, one study from Boggio et al. (2009) has shown that 3 min of anodal tDCS to the DLPFC significantly reduced ratings of unpleasantness in subjects exposed to distressing images compared to sham stimulation (Cohen's d = 0.88). Petrocchi et al. (2017) also demonstrated an increase in soothing positive affectivity (Cohen's d = 0.57) and an increase in HRV (Cohen's d = 0.26) after 15 min of 2 mA tDCS over the left temporal lobe compared to sham stimulation. However, other studies found no effect in improving the mood of healthy volunteers. It is worth mentioning that these negative studies explored the effect of a single (Morgan et al., 2014) or less than five sessions (Motohashi et al., 2013) of stimulation, and these very same studies raised the question of whether several consecutive sessions are needed to achieve mood-improving effects in non-depressed subjects. In addition, there have been no studies to our knowledge that applied tDCS as a preventive strategy to prevent future mood 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