Safety and Feasibility of Tele-Supervised Home-Based Transcranial Direct Current Stimulation for Major Depressive Disorder

Abstract

Major depressive disorder (MDD) is a worldwide cause of disability in older age, especially during the covid pandemic. Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that has shown encouraging efficacy for treatment of depression. Here, we investigate the feasibility of an innovative protocol where tDCS is administered within the homes of older adults with MDD (patient participants) with the help of a study companion (i.e. caregiver). We further analyze the feasibility of a remotely-hosted training program that provides the knowledge and skills to administer tDCS at home, without requiring them to visit the lab. We also employed a newly developed multi-channel tDCS system with real-time monitoring designed to guarantee the safety and efficacy of home-based tDCS. Patient participants underwent a total of 37 home-based tDCS sessions distributed over 12 weeks. The protocol consisted of three phases each lasting four weeks: an acute phase, containing 28 home-based tDCS sessions, a taper phase containing nine home-based tDCS sessions, and a follow up phase, with no stimulation sessions. We found that the home-based, remotely-supervised, study companion administered, multi-channel tDCS protocol for older adults with MDD was feasible and safe. Further, the study introduces a novel training program for remote instruction of study companions in the administration of tDCS. Future research is required to determine the translatability of these findings to a larger sample.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT04799405?term=NCT04799405&draw=2&rank=1, identifier NCT04799405.

Home-based transcranial direct current stimulation in dual active treatments for symptoms of depression and anxiety: A case series

“…An increased interest in home-based tDCS solutions has been growing as it removes the disadvantages of in-person visits ( 46 , 47 ). Our results show not only its promising early antidepressant effects but also the high rates of treatment adherence, potentiated by comprehensive training and remote supervision ( 37 ).…”

Toward the Development of tES- Based Telemedicine System: Insights From the Digital Transformation and Neurophysiological Evidence

“…The relationship between the social system and industry is important to the future development of tDCS usage. It is necessary to prepare the social infrastructure, including the human resources necessary to run the medical system and develop training ( 24 , 67 ). Quality control of devices is essential to ensure the safety of users in case of failure, and technology must be developed to enhance data transmission security ( 68 ).…”

“…Consequently, several ideas for telemedicine using tDCS have been proposed (14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Recently, a telemedicine depression trial was conducted with tDCS (24). Given the popularity of the research and the need for more telemedicine options highlighted by the COVID-19 pandemic, we sought to discuss the future of tDCS-telemedicine systems compatible with DX.…”

Depression and Anxiety During the COVID-19 Pandemic: Epidemiology, Mechanism, and Treatment

“…Shinjo et al reported that bifrontal transcranial direct current stimulation (tDCS) significantly reduced the severe anxiety of a patient with COVID-19 [97]. Although no random-blind controlled trials conducted during the pandemic have been reported, expert consensus considers tDCS to be a potential treatment for mental distress associated with the COVID-19 epidemic [97,98].…”