The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Transcranial direct current stimulation (tDCS) for depression in August 2015.
Transcranial direct current stimulation (tDCS) is a non-invasive method of electrical stimulation of the brain using a weak direct current applied to the scalp through electrodes. The aim is to modify cortical excitability and activity in the brain areas under the scalp electrodes. It is thought to work by the depolarisation and hyperpolarisation of cortical neurons. The patient, who remains awake and alert during the procedure, is usually seated while a portable battery-operated stimulator delivers a constant low-strength direct current to 2 saline-soaked sponge electrodes placed on the scalp. Treatment sessions typically last for about 20–30 minutes, and are repeated daily for several weeks. Treatment is usually delivered by a trained clinician, but it can also be self-administered by the patient. tDCS may be used alone or in addition to other treatments for depression.
The OPCS-4 codes for transcranial direct current stimulation for depression are:
A09.8 Other specified neurostimulation of brain
In addition, a code from the ICD-10 categories F32 Depressive episode or F33 Recurrent depressive episode may be recorded.
F32 Depressive episode or F33 Recurrent depressive episode.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.