Churning Better Transcranial Direct Current Stimulation Outcome with Accelerated Protocols: Understanding the Non-linear Dynamics through Metaplasticity
Swarna Buddha Nayok, Harsh Pathak, Vanteemar S Sreeraj, Ganesan Venkatasubramanian
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
Correspondence to: Vanteemar S Sreeraj
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029, India
E-mail: vs8sreeraj@yahoo.com
ORCID: https://orcid.org/0000-0002-2946-1228
Received: September 8, 2024; Revised: December 28, 2024; Accepted: January 22, 2025; Published online: February 27, 2025.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Recent advances in the application of transcranial direct current stimulation in psychiatry include providing about five sessions of stimulation in a short period of time with an inter-session interval of 20 minutes. Such “accelerated” protocols may reduce treatment duration and have differential neurophysiological benefits. In this narrative review, we discuss the potential impact of such protocols on the temporal aspects of metaplasticity of the neurons, non-linear behaviour of the neuronal population and brain criticality. We discuss the potential neurophysiological mechanisms involved and how to translate these mechanisms to specific stimulation parameters like duration of session, inter-session interval and number of sessions in a day. The expected benefits and necessary precautions required for accelerated protocols are also discussed.
Keywords: Neurological models; Neuronal plasticity; Nonlinear dynamics; Transcranial direct current stimulation

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