ArticleResearch square2026
Remotely Supervised Home-Based tDCS in Treatment-Resistant Depression: Feasibility, Effectiveness and EEG Biomarkers of Response.
Article in Research square, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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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