ISSN (Print): 1573-4005
ISSN (Online): 1875-6441
Volume 14, 4 Issues, 2018
ISSN (Print): 1573-4005
ISSN (Online): 1875-6441
Aims & Scope
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Transcranial direct current stimulation (tDCS) has reportedly shown promising therapeutic effects for different neuropsychiatric
disorders as well as in improving different cognitive functions in healthy individuals . It is a safe, non-invasive, and
cost-effective neuromodulating technique in which a weak direct current passes through specific regions in the brain . This
technique has been used for the treatment of different neuropsychiatric disorders such as depression , attention deficit hyperactive
disorder (ADHD) , schizophrenia , auditory hallucination , tinnitus , Alzheimer's disease (AD) , and substance
abuse . In addition, this neuromodulating technique has been used for improving different cognitive functions in
healthy individuals with promising outcomes .
This thematic issue of Current Psychiatry Reviews aims to review the applications of tDCS in the treatment of psychiatric
disorders, clinical efficacies, and future perspectives of the technique. The issue contains six reviews and tried to cover the recent
advances in using tDCS for the treatment of depression, ADHD, AD, tinnitus, schizophrenia and auditory hallucinations,
and substance abuse.
Daniel et al.  reviewed the applications of tDCS in depressive disorders (DDs) and focused on major depressive disorder
(MDD). Depression is the most frequently investigated psychiatric disorder since the emergence of tDCS as the potential
clinical treatment of disorders. The clinical efficacy of tDCS is comparable with the first generation of antidepressive pharmacological
medications. Moreover, the interesting finding is that tDCS induces antidepressive effects more rapidly than the
pharmacological medications. Therefore, tDCS can be administered as an adjunct modality to the medications effects. Furthermore,
several clinical trials showed that the administration of combined tDCS-antidepressant medications may exert cumulative
Although tDCS has not been approved for clinical application in depression treatment by FDA, the early findings are promising.
Further studies with a large sample size with randomized control design are necessary to develop tDCS as a clinical treatment
Miguel et al.  overviewed the current evidence of therapeutic outcomes of tDCS in AD and they reviewed 7 RCTs with
185 patients, of them, 4 studies supported the possible therapeutic efficacy of tDCS, whereas 3 studies did not report a significant
treatment outcome compared with the placebo groups. Anodal tDCS over frontal cortex particularly left dorsolateral prefrontal
cortex and temporal cortex showed therapeutic efficacy in AD. They concluded that further studies with controlled
group and large sample size are needed to determine effective protocols and clinical efficacy of tDCS for AD treatment. The
current evidence from clinical trials supports continuing the research to investigate anodal tDCS as an adjuvant treatment for
patients with AD.
Mirzaiyan et al.  discussed the recent advances in tDCS applications for ADHD. They focus on the mechanisms of action
and the effects of tDCS on EEG and neurotransmitters. The current evidence supports the therapeutic efficacy of tDCS in
the improvement of ADHD, but, the findings are controversial. Anodal tDCS seems to be more effective than cathodal in
ADHD. In addition, the appropriate sites of stimulation are frontal cortex in particularly left dorsolateral prefrontal cortex and
right inferior frontal gyrus. The tDCS has shown to improve inhibitory control and interference control in ADHD patients. The
literature shows promising but limited clinical efficacy of tDCS for ADHD treatment. However, the current evidence encourages
conducting further preclinical and clinical studies to understand mechanisms of action and dose response of tDCS in
ADHD to establish a clinical protocol.
Mirmomeni et al. , reviewed 7 RCTs to evaluate the clinical efficacy of tDCS in the treatment of treatment-resistant
AHs in schizophrenia patients. Their analyses of the outcome measures demonstrated incongruence in the information of the
therapeutic use of tDCS in reducing the severity of auditory hallucinations in schizophrenia. Three RCTs reported a therapeutic
benefit, manifested by reductions in severity and frequency of auditory verbal hallucinations in schizophrenic patients.
They concluded that tDCS has shown promising results in reducing the severity of auditory hallucinations in schizophrenic
patients, although in some studies its effect was negligible. TDCS offers a generally acceptable tolerability profile, which
makes it a useful alternative to the conventional medications of AHs in patients who do not wish to take medication and for
those who cannot tolerate such drugs.
Yadollahpour and Yuan  reviewed the recent tDCS applications for the treatment of addictions and substance use disorders.
Neuroimaging studies have shown the critical function of the prefrontal cortex and particularly DLPFC in addictions. PFC
plays an important role in modulating the working memory and executive functions that are usually impaired in the addictions.
Therefore, a main idea for the treatment of addictions may be modulating the activities and function of prefrontal cortex.
Therapeutic efficacies of tDCS have been reviewed for addictions to alcohol, crack-cocaine, cocaine, heroin, marijuana, methamphetamine,
and nicotine. The review showed that tDCS particularly over DLPFC and Frontal Parietal Temporal (FPT) regions
may have therapeutic effects in addictions, though the studies are few and suffer heterogeneous methodology and protocols.
Nancy et al.  in a comprehensive review overviewed the applications of tDCS in different neuropsychiatric disorders.
The current evidence from clinical trials showed the therapeutic efficacies of tDCS as adjunctive or alternative treatment option
for different neuropsychiatric disorders. TDCS due to its safe and cost-effective profile could be developed for removing the
symptoms or at least cognitive enhancement in psychiatric disorders. The review focused on the advances of tDCS applications
and the clinical efficacies for major depression, ADHD, schizophrenia, and tinnitus. TDCS, particularly bifrontal tDCS shows
treatment efficacy comparable with the first generation of antidepressive medications. The anodal tDCS over frontal cortex and
right inferior frontal gyrus shows a significant therapeutic effects in ADHD. For tinnitus the most frequent used protocols are
bifrontal and bilateral tDCS applied over DLPFC and auditory cortex respectively. Anodal tDCS over frontal cortex particularly
left DLPFC and temporal cortex showed therapeutic efficacy in AD. For schizophrenia, tDCS has shown effectiveness in
reducing the disease symptoms ranging from auditory hallucinations the effects of which were the most marked to working
memory, learning, negative and cognitive symptoms. The frequently used sites of stimulation in the schizophrenia are PFC and
temporal cortex. The clinical trials have shown that tDCS up to several sessions (10 to 15 sessions) has a safe profile so that no
serious adverse effects have been reported in the tDCS studies in different psychiatric disorders. Transient experiences of tingling,
itching, and skin redness are the most common adverse effects of the tDCS sessions [17, 18].
Current evidence from clinical trials indicates promising potential of tDCS for the treatment of different psychiatric disorders,
though the research in these areas is in the initial stage and the findings are controversial. It seems that tDCS could be
introduced at least as an adjunctive treatment for different psychiatric disorders. Further studies with a large sample size and
well-designed methods should be conducted to reach tDCS protocols for clinical applications.
After 5 decades of active practice, Dr. Habib Davanloo continues to refine his understanding of the human unconscious.
While many are familiar with the empirical evidence for the use of short-term dynamic psychotherapies, fewer are aware of the
ongoing educational program Davanloo operates in Montreal. This Montreal Closed Circuit Training Program provides extensive
competency-based, peer reviewed training to a group of international therapists.
The purpose of this special thematic issue is to update readers on Davanloo’s latest metapsychological understanding of the
unconscious and his most advanced therapeutic techniques-which have been taught exclusively in the Montreal Closed Circuit
Training Program and in Davanloo’s Annual Metapsychology of the Unconscious symposium.
In the first paper , Dr. Alan Beeber, Professor Emeritus, presents a detailed history of Davanloo’s discoveries from the
development of Intensive Short-term Dynamic Psychotherapy to the more recent Major Mobilization of the Unconscious. Beeber
presents this historical account not only as an experienced therapist and educator, but also as a participant in the training he
has had with Dr. Davanloo-- which has spanned decades. Few have had this depth and breadth of exposure and training. Beeber
captures the evolution of Davanloo’s theories and techniques in clear and comprehensive prose that conveys the formidable rate
at which Davanloo’s methods have evolved. This paper is essential reading for novice and experienced therapists alike.
Following this, Schmitt et al.  recap the historical concepts known to many in the field including bond and attachment,
unconscious anxiety, the neurobiological pathway, and the central dynamic sequence. They move on to more recent theoretical
advances include the mobilization of the transference component of the resistance and the importance of head on collision in
achieving this. This discussion is of great importance given the difficulty many therapists have in applying a well formed head
on collision and achieving a high transference component of the resistance-which are essential in the technique of major mobilization
of the unconscious. Schmitt et al. then move on to the newest concepts in the field including transference neurosis,
intergenerational transference neurosis and impairment in the unconscious defensive organization. Readers will benefit from an
updated discussion on these topics as they are new and only covered in a few other publications [3, 4].
In the third paper , these important concepts are made more tangible by applying them to a case. This case was not from
the Montreal Closed Circuit Training Program but from the private practice of one of the authors. It was shown and discussed
during the 38th Annual Metapsychology Meeting held in Montreal, Canada in 2017. It demonstrates that through dedicated
training and supervision with Dr. Davanloo, a therapist can indeed apply these rich and powerful techniques in the real world
with actual patients. In this particular case, a young woman with anorexia nervosa and a complex unconscious makes marked
therapeutic gains and is able to move forward with her life. This is the first such documented case of a therapist applying
Davanloo’s techniques in the case of a patient with an eating disorder.
It is hoped that readers of this issue will appreciate the rapid evolution of the field. More importantly, it is hoped that readers
will appreciate that Dr. Davanloo remains the sole inventor of these advanced, cutting edge techniques.
Over the past two decades, three antipsychotic medications, olanzapine (1996) quetiapine (1997) and aripirazole (2002 and
2015) are listed in the medication blockbuster list, or the list of the highest selling medications of the year. It is unclear if this
reflects an increase in the diagnosis of psychosis, a broadening of the indications for antipsychotic medications or growing prescription
rate for second generation antipsychotic medications as opposed to first generation. However, what is clear is that the
long-term risks and benefits of many psychotropic medications are unknown and that psychiatry needs an active systematic
intervention for the parsimonious use of these medication .
The first paper by Cahill et al , describes the concept of deprescribing, originally applied in geriatric and palliative care
medicine, as a systematic intervention targeted at reducing the use of potentially inappropriate medications taking medical and
functional status and preferences into consideration (Scott, Hilmer et al. 2015). The paper builds an argument for the critical
need for a similar intervention in psychiatry and outlines strategies for the implementation of deprescribing in psychiatry. It
weighs the pros and cons of applying deprescribing to psychiatry and finally, proposes a roadmap for the further validation and
development of the approach.
The second paper  by Miller et al., describes the use of collaborative strategies such as shared decision-making during
the process of deprescribing. It also details how recovery-oriented practices such as peer support, social support, personal
medicine and recovery action plans can support the individual during the deprescribing process and provides suggestions on
how to implement deprescribing collaboratively at every step.
The third paper by Mintz et al. , is a psychodynamically informed perspective on deprescribing. The paper utilizes the
authors’ experience with treating complex ‘treatment resistant’ patients and highlights the interpersonal meaning of medication
prescribing and deprescribing. The psychodynamic aspect of deprescribing including the formation of an overall diagnosis, a
focus on the therapeutic alliance and an interpersonal approach to deprescribing are elucidated using case examples.
The fourth and final paper  applies the concept of deprescribing specifically to the use of antipsychotic medications. The
paper begins with a critical examination of the evidence of the benefits of long-term antipsychotic use in chronic psychosis and
briefly reviews medication discontinuation studies. It then discusses other important reasons for considering deprescribing such
as antipsychotic polypharmacy and off-label use. In further exploring on the deprescribing process for antipsychotic medication,
the paper discusses the use of non-pharmacological interventions such as family therapy, cognitive behavioral therapy,
substance use treatments and the use of recovery tools such as well recovery action plan and personal medicine.
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