Acceptability of active and sham home-based transcranial direct current stimulation in major depression: mixed methods qualitative analysis in a randomised controlled trial

Peter J Lagerberg; Rachel D Woodham; Sudhakar Selvaraj; Nahed Lajmi; Harriet Hobday; Gabrielle Sheehan; Ali-Reza Ghazi-Noori; Maheen Rizvi; Sarah S Kwon; Paulette Orhii; Rodrigo Machado-Vieira; Jair C Soares; Allan H Young; António R Fidalgo; Hakimeh Rezaei; Cynthia H Y Fu

doi:10.1186/s12991-025-00607-4

Acceptability of active and sham home-based transcranial direct current stimulation in major depression: mixed methods qualitative analysis in a randomised controlled trial

Ann Gen Psychiatry. 2025 Dec 4;25(1):1. doi: 10.1186/s12991-025-00607-4.

Authors

Peter J Lagerberg¹, Rachel D Woodham², Sudhakar Selvaraj^{3

4}, Nahed Lajmi², Harriet Hobday², Gabrielle Sheehan², Ali-Reza Ghazi-Noori², Maheen Rizvi³, Sarah S Kwon³, Paulette Orhii^{3

5}, Rodrigo Machado-Vieira³, Jair C Soares³, Allan H Young^{6

7

8}, António R Fidalgo², Hakimeh Rezaei^{2

6

9}, Cynthia H Y Fu^{10

11

12}

Affiliations

¹ Department of Psychology, University of East London, London, UK. u1909705@uel.ac.uk.
² Department of Psychology, University of East London, London, UK.
³ Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
⁴ Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA.
⁵ Biomedical Statistical Consulting, Philadelphia, PA, USA.
⁶ Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁷ National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, London, UK.
⁸ South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.
⁹ Department of Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
¹⁰ Department of Psychology, University of East London, London, UK. c.fu@uel.ac.uk.
¹¹ Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. c.fu@uel.ac.uk.
¹² National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, London, UK. c.fu@uel.ac.uk.

Abstract

Purpose: Transcranial direct current stimulation (tDCS) is a novel non-invasive brain stimulation therapy that is a potential treatment for major depressive disorder (MDD). Acceptability impacts patient preference, treatment adherence and outcomes, however, it has typically been assessed through measures of attrition, self-reported satisfaction levels, or adverse events. We sought to explore participant acceptability using structured questionnaires and individual interviews.

Methods: Acceptability was assessed in a fully remote, multisite, double-blind, placebo-controlled, randomized superiority trial of a 10-week course of home-based tDCS for MDD. Questionnaires were conducted at baseline and at the 10-week end of treatment. Participants were 174 adults (120 women) with MDD in a current depressive episode of at least moderate severity. Active or sham tDCS was self-administered over 10 weeks with remote supervision at regular intervals. A thematic analysis was conducted.

Results: Four themes were revealed: acceptability, ease of use, side effects, and trial participation. The themes indicated generally high acceptability of tDCS as a treatment of MDD in both the active and sham treatment groups. Some participants noted concerns about the technical functionality of the device and the impact of side effects.

Conclusions: The first three themes are central to understanding participant perspectives of tDCS and its feasibility as a treatment option. In addition, the theme of trial participation highlights the value of participant support when introducing a new treatment, which may underscore treatment options in general. Furthermore, acceptability is a dynamic concept as participant views changed during treatment.

Trial registration: NCT05202119, registered on 9th January 2022.

Keywords: Home-based; Major depression; Qualitative analysis; Thematic analysis, acceptability; Transcranial direct current stimulation.

Associated data

ClinicalTrials.gov/NCT05202119

Abstract

Associated data

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