Home-Based Brain Stimulation Shows Promise for Treating Depression

A device that delivers direct brain stimulation has been shown to be a safe and effective home-based treatment for major depressive disorder (MDD) in a new study published in Nature Medicine. The trial demonstrated that a 10-week course of transcranial direct current stimulation (tDCS) significantly improved depressive symptoms.

Exploring tDCS as a treatment avenue for depression

MDD is a common and severe mental health condition characterized by persistent feelings of sadness, hopelessness and a loss of interest in activities. It can also lead to physical symptoms, such as fatigue, changes in appetite and difficulty concentrating.

Current treatment options typically include antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and psychotherapy. While these treatments can be effective, they have notable limitations. They can take weeks or even months to work, with many patients experiencing side effects like weight gain and sexual dysfunction. Up to 30% of individuals with MDD are classified as treatment-resistant, meaning they do not respond adequately to standard interventions, highlighting the need for more effective, personalized treatments.

“The burden of depression is most keenly felt by the 280 million people worldwide currently managing symptoms. While a combination of antidepressants and therapy generally proves to be effective for many people, medication can have side effects that some can find disruptive,” said corresponding author Dr. Cynthia Fu,  a professor in the department of psychology & human development at the University of East London.

tDCS is a non-invasive brain stimulation technique that uses low-intensity electrical currents to modulate neuronal activity. Electrodes are placed on the scalp to deliver a constant, mild electrical current to specific brain regions, causing an increase or decrease in neuronal excitability. tDCS has been explored for its potential to enhance cognitive functions, such as memory and attention, and to treat various neurological and psychiatric conditions. Already used in clinics to treat conditions such as psychosis and eating disorders, scientists have recently been exploring its potential in treating depression.

tDCS led to greater improvements in depressive symptoms

A total of 174 participants diagnosed with moderate to severe MDD, were enrolled in the study and randomly assigned to an active or sham treatment, which used the same device but did not provide a current. Participants received five sessions per week of a home-based tDCS treatment for three weeks, followed by a further three sessions a week for seven weeks. tDCS stimulation was provided using a study-specific installation of an app that connected to the headset via Bluetooth and each session lasted 30 minutes. Depressive symptom severity was measured at baseline and at weeks 1, 4, 7, 10 and 20.

After the 10-week course, participants receiving active tDCS had greater improvements in depressive symptoms, clinical response and remission rates compared to those receiving the sham treatment. Response and remission rates were 2–3 times higher than those in the sham group – including in cases of treatment-resistant depression and recurrent MDD – with 44.9% in the active arm demonstrating a remission rate compared to 21.8% in the control group.  

The potential of home-based therapy

“These latest results confirmed a positive profile for safety and efficacy similar to early studies with patients with depression and bipolar disorder, and the home-based therapy may facilitate access of this treatment to a larger number of patients,” said co-lead investigator Dr. Rodrigo Machado-Vieira, a professor at the Faillace department of psychiatry and behavioral sciences at McGovern Medical School.

“There is no such thing as the perfect medical intervention. Medication can have unintended side effects, while therapy is both time- and resource-intensive. Our hope is that tDCS can provide a viable third alternative for people with moderate to severe depression to help them better manage their symptoms,” said lead author Rachel Woodham, a research assistant at the University of East London.

The results highlighted that the clinical effects of tDCS continue to increase with longer treatment durations, suggesting future work could explore even longer treatment courses to maximize efficacy.

“Our core mission was, and still is, to create a treatment that is effective, safe, and accessible to as many people as possible,” said Daniel Månsson,  chief clinical officer and co-founder of Flow Neuroscience, who funded the study.

Reference: Woodham RD, Selvaraj S, Lajmi N, et al. Home-based transcranial direct current stimulation treatment for major depressive disorder: a fully remote phase 2 randomized sham-controlled trial. Nat Med. 2024. doi: 10.1038/s41591-024-03305-y

This article is a rework of a press release issued by UTHealth Houston. Material has been edited for length and content.