Rapid therapeutic response to anodal tDCS of right dorsolateral prefrontal cortex in acute mania.

Transcranial direct current stimulation is a method of noninvasive brain stimulation (NIBS) that has been intensively investigated in the last few years [1,2]. In tDCS, a weak and continuous electrical current over the scalp is applied for several minutes. If electrodes are appropriately placed and adequate parameters of stimulation are used, tDCS changes cortical excitability significantly [3]. Given the modulatory effects of tDCS, this method has been tested for mood disorders such as major depression [5,6] and bipolar disorder [6]. Although tDCS has been used for the treatment of bipolar patients, it has been used to treat depression rather than mania symptoms. Given the positive effects of other techniques of non-invasive brain stimulation for the treatment of mania such as rTMS and these initial results of tDCS for mood modulation; it is conceivable that tDCS can also induce significant reduction in symptoms of mania. Based on the neurophysiological effects of anodal stimulation and initial evidence suggesting that high frequency rTMS over the right dorsolateral prefrontal cortex might induce reduce mania symptoms [7e9], we applied 5 sessions of anodal tDCS over the right dorsolateral prefrontal cortex as an off-label treatment for a patient with an episode of mania with sexual hyperactivity.