A Novel Combined Treatment for Relapse Prevention of Depression: A Case Report

Introduction: There is plenty of evidence concerning novel treatments for major depression, as a prevalent disorder of the era. Acceptance commitment therapy (ACT), group therapy (GT), and transcranial direct current stimulation (tDCS) are the most widely used interventions, particularly for the amelioration of depressive symptoms. However, for those who receive these interventions, the risk of depression relapse is high. In this article, we have reported a depressed patient who was treated by a novel triangular systematic protocol with the advantage of relapse prevention. Case Presentation: The triangular protocol contained three stages of tDCS, ACT, and GT, which were conducted in succession. Initially, after administering tDCS, improvements were observed concerning dorsolateral prefrontal cortex (DLPFC) activation. After increasing prefrontal activity, however, the patient was complaining of remaining symptoms. Hence, we supposed it was time to work on mental reconstruction using ACT techniques. Because for most major depressive disorder (MDD) relapse following acute treatment is common, we hypothesized that administering GT after combined use of tDCS and ACT can prevent recurrence and relapse of the disease and that there will also be differences in electroencephalogram (EEG) oscillations of a depressed person after combining these methods. Conclusions: Detailed brain map of the patient and low-resolution electromagnetic tomographic analysis exhibited a marked correction of previously elevated frontal Alpha activity. According to the Beck Depression inventory-short form (BDI-SF) and Acceptance and Action questionnaire (AAQ-II), the levels of depression symptoms and psychological inflexibility were decreased, respectively. The decreasing trend was maintained after ACT and GT (stages 2 and 3). Among different times (baseline, tDCS, ACT, and GT), AAQ dramatically decreased following ACT. Similarly, the observation was maintained after the third edge of the triangle protocol. Based on the positive results of the study, it might be important for future studies with larger samples to consider the proposed protocol and might provide further evidence about the effectiveness of this method and its long-lasting effects.