COGNITIVE ENHANCING EFFECT OF RTMS COMBINED WITH TDCS IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER: A DOUBLE-BLIND, RANDOMIZED, SHAM-CONTROLLED STUDY
Authors: Zhang *Xiangyang , Li Xingxing , Liu Junyao , Wei Shuochi , Yu Chang , Wang Dongmei , Li Yuchen , Li Jiaxin , Zhuang Wenhao , Luo Rui-Chen-Xi , Li Yanli , Liu Zhiwang , Su Yuqiu , Liu Jimeng , Xu Yongming , Fan Jialin , Zhu Guidong , Xu Weiqian , Tang Yiping , Yan Hui , Cho Raymond Y , Kosten Thomas R , Zhou Dong-Sheng 
Published: February 2025

Abstract

Background
Cognitive dysfunction is one of the common symptoms in patients with major depressive disorder (MDD). Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have been studied separately in the treatment of cognitive dysfunction in MDD patients.

Aims & Objectives
We aimed to investigate the effectiveness and safety of rTMS combined with tDCS as a new therapy to improve neurocognitive impairment in MDD patients.

Method
In this brief two-week, double-blind, randomized, and sham-controlled trial, a total of 550 patients were screened, and 240 MDD inpatients were randomized into four groups (active rTMS + active tDCS, active rTMS +sham tDCS, sham rTMS + active tDCS, sham rTMS +sham tDCS). Finally, 203 patients completed the study and received 10 treatment sessions over a two-week period. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was performed to assess patients’ cognitive function at baseline and week 2. Also, we applied the 24-item Hamilton Depression Rating Scale (HDRS-24) to assess patients’ depressive symptoms at baseline and week 2.

Results
After 10 sessions of treatment, the rTMS combined with the tDCS group showed more significant improvements in RBANS total score and visuospatial/ constructional index than the other three groups (all p &lt;0.05). However, rTMS or tDCS alone was not superior to the sham group in terms of cognitive performance. In addition, the rTMS combined with tDCS group showed a greater reduction in HDRS-24 total score and a better depression remission rate than the other three groups.

Discussion & Conclusion
rTMS combined with tDCS treatment is more effective than any single intervention in treating cognitive dysfunction and depressive symptoms in MDD patients.

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