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. 2023 Nov 2:14:1206805.
doi: 10.3389/fpsyt.2023.1206805. eCollection 2023.

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

Theodoros Koutsomitros  1   2   3 , Sandra A Schwarz  1 , Kenneth T van der Zee  1   4 , Teresa Schuhmann  1   5 , Alexander T Sack  1   5   6
Affiliations

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

Theodoros Koutsomitros et al. Front Psychiatry. .

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.

Method: Over 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.

Results: Of 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.

Keywords: asynchronous remote supervision; depression; home-administered; major depressive disorder (MDD); remotely supervised; transcranial direct current stimulation (tDCS); transcranial electrical stimulation (TES); treatment resistant depression (TRD).

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Conflict of interest statement

AS is the Chief Scientific Advisor for PlatoScience Medical, Scientific Advisor for Alpha Brain Technologies, Founder and CEO of Neurowear Medical, Director of the International Clinical TMS Certification Course (www.tmscourse.eu), and President of the Academy of Brain Stimulation (www.brainstimulation-academy.com). He has received equipment support from MagVenture, Magstim, and Deymed Diagnostics. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
tDCS headset and electrode positioning. (A) Two figures depicting the PlatoWork 2.0 tDCS headset (PlatoScience ApS, Denmark). (B) A schematic showing the targeted stimulation locations of F3 and F4, with the anode in blue and the cathode in red, according to the International 10-20 EEG System. Images reproduced with permission from the manufacturer.
Figure 2
Figure 2
Change in BDI score comparing the score at baseline to the 3-week therapy. This interaction between the treatment group and the change in BDI score over time was significant, t(118) = 2.181, p = 0.031. Pairwise comparisons showed a significant decrease in BDI score when comparing the two groups at the 3 week timepoint [t(35) = 3.255, p = 0.038]. *Significant (p < 0.05) difference. NB. TAU, treatment as usual; tDCS, transcranial direct current stimulation.
See this image and copyright information in PMC

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