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It is your right to be informed of the risks and benefits associated with the use of non-invasive brain stimulation to assist with your counselling treatment plan. You have the right to make an informed decision to withdraw or participate in any session involving transcranial direct current stimulation (tDCS). Your consent is voluntary and can be withdrawn for any reason. 

 

What is tDCS?

Transcranial Direct Current Stimulation (tDCS) involves the non-invasive delivery of a low intensity electric field to the brain through a small, portable battery-operated device. Approved by Health Canada, tDCS has been shown to have antidepressant effects and is also approved for the treatment of fibromyalgia and migraine.  tDCS has a number of off-label uses that are yet to be approved, but have solid research evidence supporting their benefits.

 

Side Effects of tDCS

Potential side-effects of tDCS include itchiness, tingling, scalp burning, irritation, and/or redness on the head beneath the electrode pad; drowsiness; headache; concentration problems; mood changes; and nausea; Please report any effects you experience during the sessions, as there are protocols in place to increase your comfort. Rare potential side-effects of tDCS include burns due to metal implants/piercings; skin lesions and/or exacerbation of pre-existing injuries on the scalp, skin, or head; seeing a flash of light at the start or end of a session; and transmission of infection. Although no serious side effects should occur, please report any effects you experience during the sessions. Safeguards such as rigorous staff training, consultation with medical professionals, and client screening have been implemented to prevent serious side effects. 

 

tDCS Course of Treatment

Step 1:  Pre-screening (before first appointment), including Edinburgh Handedness Inventory

Step 2:  Mental Health history and treatment planning (first appointment)

-the therapist will gather a history of your mental/emotional/behaviour health and conduct baseline assessments of your mood and general functioning, as well as screen for possible risks that may emerge during treatment

-once you are assessed to be an eligible candidate for tDCS, you and the therapist will select a tDCS protocol that is best suited to your current needs and resources

Step 3:  tDCS Measurements (second appointment)

-in order to determine the proper regions for stimulation, the therapist will calculate and record measurements of your personal 10/20 system of electrode placement

Step 4:  Stimulation (second and subsequent appointments)

-electrodes will be placed on the targeted regions for the specified length of time, during which you will relax quietly under the therapist’s observation, or engage in therapeutic conversation as per your plan

Step 5:  Comfort Rating Questionnaire (second and subsequent appointments)

-after every tDCS session you will be asked to complete a questionnaire to document the presence of any side effects

Step 6:  Follow-Up (second and subsequent appointments)

-you will be asked to record any changes you notice in mood or functioning, particularly in the 24h following your session

Steps 4-6 will continue until your treatment plan has ended

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References

Bashir S, Yoo WK. Neuromodulation for Addiction by Transcranial Direct Current Stimulation: Opportunities and Challenges. Ann Neurosci. 2016;23(4):241-245. doi:10.1159/000449485

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Bennabi, D., & Haffen, E. (2018). Transcranial Direct Current Stimulation (tDCS): A Promising Treatment for Major Depressive Disorder?. Brain sciences, 8(5), 81. https://doi.org/10.3390/brainsci8050081

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Klauss, J., Anders, Q., S., Felippe, L. V., Nitsche M. A., Nakamura-Palacios, E. M. (2018).  Multiple Sessions of Transcranial Direct Current Stimulation (tDCS) Reduced Craving and Relapses for Alcohol Use: A Randomized Placebo-Controlled Trial in Alcohol Use Disorder.  Frontiers in Pharmacology 9. https://www.frontiersin.org/article/10.3389/fphar.2018.00716  

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Lapenta, O. M., Marques, L. M., Rego, G. G., Comfort, W. E., & Boggio, P. S. (2018). tDCS in Addiction and Impulse Control Disorders. The journal of ECT, 34(3), 182–192. https://doi.org/10.1097/YCT.0000000000000541

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Lefaucheur, J. P., Antal, A., Ayache, S. S., Benninger, D. H., Brunelin, J., Cogiamanian, F., Cotelli, M., De Ridder, D., Ferrucci, R., Langguth, B., Marangolo, P., Mylius, V., Nitsche, M. A., Padberg, F., Palm, U., Poulet, E., Priori, A., Rossi, S., Schecklmann, M., Vanneste, S., … Paulus, W. (2017). Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 128(1), 56–92. https://pubmed.ncbi.nlm.nih.gov/27866120/

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May, B.  (2020).  Transcranial Direct Current Stimulation Produces Moderate Benefits for Depression.  Psychiatry Advisor.  https://www.psychiatryadvisor.com/home/depression-advisor/transcranial-direct-current-stimulation-produces-moderate-benefits-for-depression/

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Zanardi, R. , Poletti, S., Prestifilippo, D., Attanasio, F., Barbini, B., Colombo, C.  (2020). Transcranial direct current stimulation: A novel approach in the treatment of vascular depression. Brain Stimulation, 13(6),  1559-1565. https://doi.org/10.1016/j.brs.2020.08.013

 

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