Efficacy of transcranial direct current stimulation for depression: individual patient data meta-analysis

Lais B Razza; Matthias S Luethi; Adriano Moffa; Sabine Aust; Daniel M Blumberger; Jerome Brunelin; Gerrit Burkhardt; Cecilia Chiarenza; Colleen K Loo; Remi Moirand; Woojae Myung; Camilla L Nord; Ulrich Palm; Rebecca Segrave; Leandro Valiengo; Frank Padberg; Alexandre Paim Diaz; André R Brunoni; Marie-Anne Vanderhasselt

doi:10.1192/bjp.2025.10511

Efficacy of transcranial direct current stimulation for depression: individual patient data meta-analysis

Br J Psychiatry. 2026 Jan 7:1-10. doi: 10.1192/bjp.2025.10511. Online ahead of print.

Authors

Lais B Razza¹, Matthias S Luethi², Adriano Moffa^{3

4}, Sabine Aust⁵, Daniel M Blumberger^{6

7}, Jerome Brunelin⁸, Gerrit Burkhardt⁹, Cecilia Chiarenza¹⁰, Colleen K Loo^{3

4}, Remi Moirand⁸, Woojae Myung^{11

12}, Camilla L Nord^{13

14}, Ulrich Palm¹⁵, Rebecca Segrave¹⁶, Leandro Valiengo², Frank Padberg⁹, Alexandre Paim Diaz¹⁷, André R Brunoni¹⁸, Marie-Anne Vanderhasselt¹

Affiliations

¹ Ghent, Experimental Psychiatry (GHEP) Lab, Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent Universityhttps://ror.org/00cv9y106, Ghent, Belgium.
² Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
³ School of Psychiatry, University of New South Wales, Sydney, Australia.
⁴ Black Dog Institute, Sydney, Australia.
⁵ Charité - University Medicine Berlin, Department of Psychiatry, Campus Benjamin Franklin, corporate member of the Free University of Berlin, Humboldt University of Berlin and the Berlin Institute of Health, Berlin, Germany.
⁶ Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada.
⁷ Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁸ Le Vinatier Hospital, Claude Bernard University Lyon 1, French National Centre for Scientific Research (CNRS), French National Institute of Health and Medical Research (INSERM), Lyon Neuroscience Research Center (CRNL), U1028 UMR5292, Bron, France.
⁹ Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany.
¹⁰ Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy.
¹¹ Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
¹² Department of Psychiatry, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
¹³ MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
¹⁴ Department of Psychiatry, University of Cambridge, Cambridge, UK.
¹⁵ Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany.
¹⁶ BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Clayton, Victoria, Australia.
¹⁷ University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
¹⁸ Division of Interventional Psychiatry, Department of Psychiatry and Peter O'Donnell Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA.

PMID: 41498282
DOI: 10.1192/bjp.2025.10511

Abstract

Background: Transcranial direct current stimulation (tDCS) shows promise for treating depression, but heterogeneous findings from randomised controlled trials (RCTs) - likely due to patient characteristics and methodological differences - limit clear conclusions about its efficacy.

Aims: This individual patient data meta-analysis (IPD-MA) aims to evaluate the efficacy of tDCS for depression and explore moderators of clinical depression improvement.

Method: Databases (PubMed, Embase, Web of Science, Cochrane Library) were searched up to 1 February 2025 for RCTs comparing active versus sham tDCS in acute depressive episodes. The outcomes were Hedges' g for continuous measures of depressive symptoms, odds ratio for response and remission rates and analyses of individual/methodological moderators of clinical improvement. Acceptability was assessed via dropout rates. Heterogeneity was quantified using the I² statistic. Publication and risk of bias were evaluated with Egger's test and Cochrane Risk of Bias Tool, respectively.

Results: Of 29 eligible RCTs, 18 data-sets provided IPD, totalling 1246 included in the IPD-MA (651 active, 595 sham; mean age 43.2, 63.4% female). Most studies (90%) had low risk of bias. Active tDCS showed small but statistically significant effects on depression improvement (Hedges' d = 0.24, 95% CI = 0.11-0.35) and response rates (odds ratio 1.33, 95% CI = 1.04-1.72), with low-to-moderate heterogeneity. No significant difference in remission rates (odds ratio 1.30, 95% CI = 0.98-1.74) and dropout rates (12.7% active, 11.3% sham) were observed between groups. Only sample size significantly moderated clinical improvement, with larger trials showing smaller between-group differences.

Conclusions: In this IPD data-set, tDCS showed modest efficacy for depression. Future research should clarify its mechanisms, considering non-specific placebo effects.

Keywords: Depression; individual patient data meta-analysis; non-invasive brain stimulation; systematic review; transcranial direct current stimulation.

Publication types

Review