A new study provides promising evidence that delivering transcranial direct current stimulation (tDCS) remotely in people’s homes could be an effective treatment approach for major depressive disorder. The key facts are:
- tDCS is a form of non-invasive brain stimulation that uses electrical currents to modulate activity in targeted brain regions.
- When applied to the left dorsolateral prefrontal cortex, tDCS has been shown to have antidepressant effects in multiple studies.
- This new study tested a telehealth platform that enabled participants to self-administer tDCS sessions at home with remote supervision.
- Over a 10-week treatment period, tDCS led to significant reductions in depressive symptoms that continued to improve over time.
Source: Frontiers in Psychiatry (2023)
Transcranial Direct Current Stimulation as a Treatment for Depression
Transcranial direct current stimulation (tDCS) is a form of non-invasive neuromodulation that delivers low intensity electrical current to the brain through electrodes placed on the scalp.
The current modulates the excitability of targeted cortical regions and their functional connections.
When applied to the left dorsolateral prefrontal cortex (DLPFC), tDCS has been found to have antidepressant effects, significantly reducing symptoms of major depressive disorder.
Multiple randomized controlled trials and meta-analyses have provided evidence for left DLPFC tDCS as an effective treatment approach for depression.
For example, a 2016 meta-analysis of individual patient data from 6 randomized sham-controlled trials found that active tDCS treatment was associated with significantly improved response and remission rates compared to sham stimulation.
Based on the level of evidence, tDCS has been granted a Level A classification by the Canadian Network for Mood and Anxiety Treatments as an effective intervention for adults with major depressive disorder.
TDCS as a Telehealth or At-Home Depression Treatment
While most clinical trials of tDCS for depression have involved in-clinic treatment sessions, there has been growing interest in exploring tDCS as a telehealth intervention that could be delivered remotely to patients in their own homes.
Telehealth tDCS offers a number of potential advantages, including overcoming barriers to access, reducing costs, and improving scalability.
It also enables administration of the repeated sessions likely needed for optimal antidepressant efficacy.
Some initial studies have demonstrated that telehealth-delivered tDCS is feasible, safe, and reliable.
For example, a 2018 study tested a remotely supervised tDCS protocol involving real-time video conferencing.
Patients self-administered left DLPFC tDCS in their homes for 5 sessions per week over 4 weeks.
The study found high rates of compliance and no serious adverse events.
While promising, evidence on telehealth tDCS for treating depression has remained limited.
Further research is still needed to firmly establish its efficacy in large controlled trials mimicking real-world clinical implementations.
Study Tests “At Home” TDCS for Depression (2023)
Contributing important new evidence in this area, researchers at New York University Langone Health (NYULH) recently completed an observational clinical trial evaluating the effectiveness of a telehealth tDCS protocol for depression treatment.
The study enrolled 24 participants diagnosed with moderate to severe major depressive disorder, with 16 participants completing the full study protocol.
The participants were given tDCS devices and electrodes to self-administer remotely supervised treatment sessions from home.
The telehealth tDCS intervention consisted of an initial acute phase with 28 tDCS sessions (5 per week for 6 weeks), followed by a 4-week tapering phase of once weekly treatments.
Each 30-minute tDCS session targeted the left DLPFC at an intensity of 2.0 mA. During the sessions, participants also listened to a 10-minute guided mindfulness meditation and 20 minutes of relaxing music.
Antidepressant Effect from TDCS: Reduction in Depressive Symptoms (Results)
Analysis of the results showed that the telehealth tDCS protocol led to statistically significant improvements in depression severity over the course of treatment.
The primary outcome measure was the Montgomery-Åsberg Depression Rating Scale (MADRS), a standard clinical assessment of depressive symptoms.
MADRS scores decreased significantly from severe at baseline (mean 28.0) to mild levels by the end of treatment (mean 8.1).
The reductions in MADRS were apparent by just the second week of treatment and continued to improve across subsequent timepoints.
By the end of the acute phase at 6 weeks, 75% of participants were classified as treatment responders (≥50% MADRS reduction).
After completing the full protocol, the response rate increased to 88% and remission rate (MADRS≤10) reached 81%.
The MADRS results were supported by significant improvements observed on secondary outcome measures of depressive symptoms and quality of life.
For example, the Quick Inventory of Depressive Symptomatology self-report scores improved from moderate-severe symptoms at baseline to mild levels by week 10.
The telehealth tDCS intervention was also found to be safe and well-tolerated.
There were no serious adverse events and no need for treatment discontinuation due to issues tolerating tDCS.
Overall, this rigorous clinical trial provides evidence that remotely supervised tDCS delivered to patients’ homes could offer an effective approach for alleviating depressive symptoms.
The high rates of response and remission are particularly promising and supportive of tDCS’ antidepressant effects.
Study Limitations & TDCS Optimization for Depression
This study represents an important step in developing tDCS protocols that can be effectively delivered via telehealth platforms.
While promising, some limitations should be highlighted to inform future research directions and clinical implementations.
First, the study had an open-label design without a sham control group.
Placebo effects could therefore have influenced the magnitude of improvements observed.
Future large scale RCTs with sham controls are needed to confirm the efficacy of remotely supervised tDCS for depression.
Second, the sample size was relatively small at only 16 completers.
Larger studies should aim to enroll more representative patient populations to increase generalizability.
The study also required self-payment, so participants were limited in socioeconomic diversity.
Third, enhancements of the tDCS intervention could be explored, such as synchronizing the stimulation with cognitive or behavioral therapy tasks.
The effects of the mindfulness and music components should also be parsed out.
Fourth, further research is needed to identify which patients are most likely to benefit from telehealth tDCS and inform optimal dosing protocols.
Monitoring systems could help customize and maximize treatment effectiveness for individual patients over time.
Finally, while this study focused on an initial treatment protocol, research is needed on maintenance tDCS schedules to sustain antidepressant effects and prevent relapses.
Conclusion: At-Home TDCS Shows Preliminary Promise for Depression
In conclusion, this well-conducted clinical trial provides important evidence supporting the potential of remotely supervised tDCS as an innovative approach to improve access and efficacy of non-invasive brain stimulation therapy for depression treatment.
As technology enhances the practicality and personalization of tDCS, telehealth protocols could pave the way toward making tDCS a viable first-line treatment option for major depressive disorder.
With continued research, user-friendly at home tDCS platforms could be a scalable and cost-effective way to alleviate the disease burden of this highly prevalent mental health condition.
- Paper: Home-administered transcranial direct current stimulation is a feasible intervention for depression: an observational cohort study (2023)
- Authors: Leigh Charvet et al.