Home-Based tDCS for Depression: Is Remote Supervision Effective?

Author Names

Theodoros Koutsomitros, Sandra A. Schwarz, Kenneth T. van der Zee, Teresa Schuhmann and Alexander T. Sack

Published Date: November 2023

Journal Name: Frontiers in Psychiatry

Abstract

This study investigates the feasibility, tolerability, and clinical effectiveness of home-administered transcranial direct current stimulation (tDCS) with asynchronous remote supervision in treating major depressive disorder (MDD). Over three weeks, 40 patients with MDD participated, with half receiving daily bi-frontal tDCS alongside psychotherapy, while the other half received psychotherapy only. The results indicate significant improvements in depression symptoms for the tDCS group compared to the treatment-as-usual (TAU) group. The study concludes that home-based tDCS with remote supervision is a feasible and effective treatment option for depression.

Key Concepts

• Transcranial Direct Current Stimulation (tDCS): A non-invasive brain stimulation technique that uses a low-intensity electrical current to modulate neuronal activity.

• Major Depressive Disorder (MDD): A mental health condition characterized by persistent sadness and loss of interest, affecting daily functioning.

• Remote Supervision: Monitoring patients’ use of tDCS at home via a cloud-based platform, allowing clinicians to oversee treatment without real-time interaction.

• Literature Review: Previous studies have shown that tDCS can be an effective treatment for depression, particularly when combined with psychotherapy or pharmacotherapy. Home-based tDCS has been explored as a convenient alternative to in-clinic sessions, with positive results in terms of feasibility and effectiveness.

Procedure Highlights - Research Methodology

1. Study Design: An open-label naturalistic study conducted over three weeks.

2. Participants: 40 patients diagnosed with MDD, divided into two groups: 20 received tDCS plus psychotherapy, and 20 received only psychotherapy.

3. tDCS Protocol: Patients in the tDCS group received 30-minute daily sessions at 2 mA, using a bi-frontal montage targeting the dorsolateral prefrontal cortex (DLPFC).

4. Supervision: Asynchronous remote supervision was provided using a cloud-based platform to monitor compliance and side effects.

5. Outcome Measures: Depression symptoms were assessed using the Beck Depression Inventory (BDI) at four time points: baseline, and after each of the three weeks of treatment.

Results - Findings of the Research

• Clinical Response: 50% of patients in the tDCS group showed a clinical response, defined as a 50% reduction in BDI score, compared to only 5% in the TAU group.

• Remission Rates: 75% of patients in the tDCS group achieved remission (BDI score below 13) by the end of the study, compared to 30% in the TAU group.

• Symptom Reduction: The tDCS group showed a significantly greater reduction in depression symptoms after three weeks compared to the TAU group, with a mean BDI score decrease of 17.5 points.

• Feasibility and Tolerability: 90% of the tDCS group adhered to the protocol, missing no more than three sessions. Side effects were mild and included minor scalp discomfort in a few cases.

Discussion and Conclusion of the Research

The study demonstrates that home-administered tDCS with asynchronous remote supervision is a feasible, tolerable, and effective treatment for patients with MDD.

The significant improvements in depression symptoms observed in the tDCS group, along with high remission rates, support the potential of this approach as an alternative to traditional in-clinic treatments.

The findings suggest that home-based tDCS could be integrated into clinical practice, offering a flexible and scalable solution for managing depression.

Link to the Original Paper

Home-administered transcranial direct current stimulation with asynchronous remote supervision in the treatment of depression: feasibility, tolerability, and clinical effectiveness

Author Information

• Theodoros Koutsomitros: Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Netherlands

• Sandra A. Schwarz: Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Netherlands

• Kenneth T. van der Zee: Donders Institute, Centre for Cognitive Neuroimaging, Radboud University, Netherlands

• Teresa Schuhmann: Brain Imaging Centre, Maastricht University, Netherlands

• Alexander T. Sack: School for Mental Health and Neuroscience, Maastricht University Medical Centre, Netherlands

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