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Butyrylcholinesterase Atypical Mutation in a Patient Undergoing Electroconvulsive Therapy.

response, noninvasive neuromodulation approaches such as transcranial direct current stimulation (tDCS) may be an option for these patients because tDCS clinical effects have an antidepressant effect for different populations. The effects of tDCS for patients undergoing hemodialysis have not been assessed hitherto. We conducted an open-label trial on the efficacy of a 10-day tDCS protocol for patients undergoing hemodialysis diagnosed as having depression. Patients undergoing hemodialysis in an academic service underwent screening by a trained psychiatrist. All participants were diagnosed as having major depressive episodes according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria. Patients underwent a 10-session tDCS protocol consisting of tDCS sessions every other day during a 3-week period. The sessions took place during the hemodialysis sessions. The anode was located over the left dorsolateral prefrontal cortex, and the cathode was positioned contralaterally. We used a direct current of 2.0 mA for 20 minutes. Participants were not receiving any other modality of treatment for depression and provided informed consent. The study was approved by the local institutional review board. A total of 8 patients fulfilled eligibility criteria (75% females, mean age of 54 ± 14.9 years). Baseline assessment showed a Hamilton Rating Scale for Depression (HRSD) mean score of 17.5 (±5.39), whereas the Beck Anxiety Inventory mean baseline score was 13.5 (±7.27). After the end of treatment, HRSD = −17 scores dropped 9.87 (±5.6) points (t7 = 4.90; P = 0.0017), and HRSD-17 scores remained stable during 1 month of follow-up (t7 = 1.16; P = 0.288). Exploratory analysis also showed a significant reduction of anxiety symptoms (mean change of 5.12 ± 1.94; t7 = 2.64; P = 0.03) as assessed by the Beck Anxiety Inventory. The improvement was also sustained during follow-up (t7 = 1.67; P = 0.137). Regarding possible cofounders, we performed multiple regressions as to verify the influence of clinical (clinical diagnosis, time under hemodialysis protocol, number of comorbidities, psychiatric history) and demographical (sex, income, education) variables.We found no cofounder related to primary outcome. There were no severe adverse effects. Every patient referred a mild transient paresthesia under the electrode site during stimulation. We had no dropouts. Our results indicate a possible clinical benefit of tDCS protocol in ameliorating depressive symptoms in patients undergoing hemodialysis. The study’s limitations include the small sample size, its unblinded