# Remotely Supervised Home-Based tDCS in Treatment-Resistant Depression: Feasibility, Effectiveness and EEG Biomarkers of Response

## TL;DR

Home-based tDCS for depression was found to be feasible and effective, with some users showing significant symptom reduction and potential EEG markers for response identified.

## Contribution

This study provides real-world evidence on the feasibility and effectiveness of remotely supervised home-based tDCS for treatment-resistant depression.

## Key findings

- 88% of scheduled tDCS sessions were completed by participants.
- Depressive symptoms decreased significantly across multiple measures.
- EEG markers like left-frontal alpha power and TMS-EEG evoked potentials may predict treatment response.

## Abstract

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.

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.

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.

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.