Multichannel tDCS with Advanced Targeting for Major Depressive Disorder: A Tele-Supervised At-Home Pilot Study

Abstract

PurposeProof-of-principle human studies suggest that transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (L-DLPFC) may improve the clinical symptoms of depression. This multicenter study (N=35) tested remotely supervised and repeated daily multichannel tDCS delivered at home designed to target the L-DLPFC in a group of patients with major depressive disorder (MDD). The main objectives of the study were to assess the feasibility and safety of home-based, remotely-supervised tDCS for patients with MDD. As an exploratory aim, we also aimed to evaluate the efficacy. The primary efficacy measure for this study was the median percent change from baseline to the end of the 4-week post-treatment follow-up period in the observer-rated Montgomery-Asberg Depression Mood Rating Scale (MADRS).MethodsFor each study participant, this open-label feasibility telemedicine pilot study involved 37 at-home stimulation sessions (30 minutes each) of multichannel tDCS targeting L-DLPFC administered over eight weeks, with a follow-up period of 4 weeks following the final stimulation session. The stimulation montage (electrode positions and currents) was optimized by employing computational models using available structural data from a similar population (group optimization). Conducted entirely remotely, the study employed the MADRS for assessment at baseline, at weeks 4 and 8 during treatment, and at 4-week follow-up visits.ResultsThe population who completed all study visits consisted of 34 patients (85.3% women and 14.7% men) with a mean age of 59 years, a diagnosis of MDD according to DSM-V criteria, and a MADRS score ≥20 at the time of study enrolment. At baseline, the mean time since MDD diagnosis was 24.0 (SD 19.1) months. Nearly 90% of the participants (n=29) completed the full course of 37 stimulation sessions at home, covering both the acute and taper phases. No detrimental effects were observed, and no participants had suicidal ideation and/or behavior, whether at baseline during treatment or during the four weeks post-treatment. The study observed a Median percentage MADRS score reduction of 64.5% (48.6, 72.4). Over 70% of participants (n=24) showed a ≥ 50% improvement in MADRS scores from baseline to the last visit (4 weeks post-treatment), with a response rate (RR) of 72.7%. Secondary measures, including the Quick Inventory of Depressive Symptomatology-Self Report (QUIDS-SR) and the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), reflected similar improvements. The mean (SD) and the median difference between the final visit and baseline for the Q-LES-Q-SF score were 27.9 (13.8) and 26.8 (17.9, 35.7), respectively.ConclusionsThese results suggest that remotely supervised and supported home-based tDCS is safe and feasible, and antidepressant efficacy motivates further appropriately controlled clinical studies.