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

Abstract

Introduction (Background)Depression is an often chronic condition, characterized by wide-ranging physical, cognitive and psychosocial symptoms that can lead to disability, premature mortality or suicide. It affects 350 million people globally, yet up to 30% do not respond to traditional treatment, creating an urgent need for novel non-pharmacological treatments. This open-label naturalistic study assesses the practical feasibility, tolerability, and clinical effectiveness of home-administered transcranial direct current stimulation (tDCS) with asynchronous remote supervision, in the treatment of depression.MethodOver the course of 3 weeks, 40 patients with depression received psychotherapy and half of this group also received daily bi-frontal tDCS stimulation of the dorsolateral prefrontal cortex. These patients received tDCS for 30 min per session with the anode placed over F3 and the cathode over F4, at an intensity of 2 mA for 21 consecutive days. We measured patients' level of depression symptoms at four time points using the Beck Depression Inventory, before treatment and at 1-week intervals throughout the treatment period. We monitored practical feasibility such as daily protocol compliance and tolerability including side effects, with the PlatoScience cloud-based remote supervision platform.ResultsOf the 20 patients in the tDCS group, 90% were able to comply with the protocol by not missing more than three of their assigned sessions, and none dropped out of the study. No serious adverse events were reported, with only 14 instances of mild to moderate side effects and two instances of scalp pain rated as severe, out of a total of 420 stimulation sessions. Patients in the tDCS group showed a significantly greater reduction in depression symptoms after 3 weeks of treatment, compared to the treatment as usual (TAU) group [t(57.2) = 2.268, p = 0.027]. The tDCS group also showed greater treatment response (50%) and depression remission rates (75%) compared to the TAU group (5 and 30%, respectively).Discussion (Conclusion)These findings provide a possible indication of the clinical effectiveness of home-administered tDCS for the treatment of depression, and its feasibility and tolerability in combination with asynchronous supervision.

Transcranial Direct Current Stimulation to Ameliorate Post-Stroke Cognitive Impairment

“…Capacity for remote use invites a broader and more accessible intervention, but it also risks inconsistencies in use when it is self-administered by the participant rather than the research staff. These challenges may be mitigated by requiring hands-on pre-intervention training for research participants to learn and practice with the technology and real-time monitoring of treatment fidelity through videoconferencing [ 72 , 73 , 74 , 75 , 76 ]. A single center reported findings from its studies involving 6779 participants who underwent remotely supervised tDCS and found no serious adverse events, few study discontinuations due to tolerability (0.04%), and there was high treatment fidelity (92–98%) [ 75 ].…”

“…A single center reported findings from its studies involving 6779 participants who underwent remotely supervised tDCS and found no serious adverse events, few study discontinuations due to tolerability (0.04%), and there was high treatment fidelity (92–98%) [ 75 ]. Remote tDCS has been used in studies of a wide variety of neuropsychiatric conditions including multiple sclerosis [ 72 ], Parkinson’s disease [ 74 ], major depressive disorder [ 76 ], depression, [ 77 ], and stroke [ 78 ], to name a few.…”