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Remotely Supervised Home-Based tDCS in Treatment-Resistant Depression: Feasibility, Effectiveness and EEG Biomarkers
Rubén Romero-Marín1, Sergi López-Rodríguez1, Sara Lakis-Granell2
1Institut Guttmann Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Spain.
Background:
Remotely supervised home-based transcranial direct current stimulation (HB-tDCS) may expand access to neuromodulation for treatment-resistant depression (TRD), but real-world evidence on candidate biomarkers remains limited.
Methods:
In this naturalistic pre-post study, 40 adults with major depressive disorder and inadequate response to ≥ 2 treatments were enrolled. After MRI/clinical screening, 2 were excluded for potential stimulation contraindications and 5 did not start or discontinued within the first sessions for personal reasons unrelated to stimulation. 33 participants completed a 6-week semi-supervised HB-tDCS protocol (42 sessions, 30 min, 2 mA; anode F3/cathode F4). Baseline and post-treatment assessments included clinician-rated and self-rated depression (MADRS, QIDS-SR16, BDI-II), global cognition (MoCA), quality of life (Q-LES-Q-SF), and neurophysiological markers (resting-state EEG and TMS-EEG). Feasibility, technical incidents, and adverse effects were recorded after each session.
Results:
Completers delivered 1,219/1,386 scheduled sessions (88%). Depressive symptoms decreased from baseline to post-treatment (MADRS - 24%, QIDS-SR16 - 15%, BDI-II - 12%; all p≤.002). Sixteen of 33 (48.5%) achieved ≥ 25% MADRS reduction (partial response), including 5 (15.2%) with ≥ 50% reduction. MoCA improved modestly, whereas Q-LES-Q-SF did not change significantly. Adverse effects were mostly mild/moderate (e.g., tingling, headache, scalp dryness), and no stimulation-related serious adverse events occurred. Exploratory analyses suggested higher baseline left-frontal alpha (F3) relative power and TMS-EEG evoked potentials in the left DLPFC (P30, P180) differentiated responders from non-responders.
Conclusions:
An intensive, semi-supervised HB-tDCS program was feasible and well tolerated in TRD and was associated with clinically meaningful symptom reductions. Candidate EEG/TMS-EEG markers warrant replication in controlled trials.
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