2026 ECNP Congress

PS04-4120

Transcranial direct current stimulation (tDCS) as maintenance therapy following rTMS in depression: a proof-of-concept study

Sofia Pappa — J. Barnett, M. Simon-Norris, S. Thapa, M. Tai, T. Chester, J. Wilson, D. Zygmunt, M. Toynbee · West London NHS Trust, Neuromodulation, London, United Kingdom

2026 ECNP Congress

Background

Repetitive transcranial magnetic stimulation (rTMS) is a proven and effective intervention for treatment-resistant depression; however, relapse following successful response remains a significant clinical challenge, particularly in the absence of an established maintenance strategy. Transcranial direct current stimulation (tDCS) is a well-tolerated, non-invasive, home-delivered neuromodulation technique with an expanding evidence base in depression [1,2]. Its portability and feasibility for longer-term use, together with flexible delivery, make it a promising candidate for maintenance following rTMS [3]. Currently, there is very limited data examining its role specifically in this context. To our knowledge, no previous studies have evaluated tDCS as a maintenance approach following rTMS in a clinical cohort, and this study was designed as a proof-of-concept investigation.

Methods

This proof-of-concept naturalistic study examined patients with depressive disorders receiving tDCS as maintenance therapy following a course of rTMS. Participants were treated within a routine secondary care NHS setting and tDCS was offered where clinically indicated to maintain treatment response. Symptom severity was primarily measured using the Montgomery–Åsberg Depression Rating Scale (MADRS) at baseline, 6 weeks, and 12 weeks. Additionally, Patient Health Questionnaire-9 (PHQ-9) scores were available for a subset of patients at baseline and 6 weeks. Adverse effects, discontinuation rates and discontinuation reasons were recorded throughout. Basic demographic and clinical information were collected, and data were analysed descriptively.

Results

A total of 10 patients were included (8 female, 2 male), with a mean age of 41.7 years (range 28–64); the cohort was 80% White, 10% Black and 10% Other ethnicities. All patients (100%) completed 6 weeks of treatment, and 8 (80%) completed 12 weeks. One patient discontinued due to subjective lack of benefit, the other patient’s reason for discontinuing is not known. Mean MADRS scores (n=10/10) reduced from 25.1 at baseline to 18.0 at 6 weeks, a reduction of 28.3%. Among those who completed 12 weeks of treatment (n=8/10), scores reduced from 23.1 at baseline to 16.1 at 12 weeks, corresponding to a reduction of 30.3%. For those patients with available PHQ-9 data (n=5/10), scores reduced from 16.4 at baseline to 9.0 at 6 weeks, a reduction of 45.1%. Treatment was generally well tolerated, with the most commonly reported side effects being mild skin irritation (40%) and headache (20%). No serious adverse events were observed.

Conclusions

This is the first study evaluating tDCS as neuromodulation maintenance following clinical response to rTMS. tDCS was associated with sustained clinical improvement post rTMS and was well tolerated. In addition, patients experienced substantial further improvement at 6 weeks, which was maintained at 12 weeks. As a proof-of-concept study, this work provides preliminary support for the role of tDCS in post-rTMS care and highlights a novel area for further investigation. Future studies should aim to evaluate efficacy in relapse prevention and to determine optimal maintenance protocols.

References

  1. Ren, C., Pagali, S.R., Wang, Z., et al., 2025. Transcranial electrical stimulation in treatment of depression: A systematic review and meta-analysis. JAMA Network Open 8 (6), e2516459. doi:10.1001/jamanetworkopen.2025.1645
  2. Moshfeghinia, R., Bordbar, S., Roointanpour, Y., et al., 2025. Efficacy and safety of home-based transcranial direct current stimulation (tDCS) on patients with depressive disorders: A systematic review and meta-analysis of randomized clinical trials. Scientific Reports 15, 43850. doi:10.1038/s41598-025-28648-5
  3. Woodham, R. D., Selvaraj, S., Lajmi, N., et al., 2025. Home-based transcranial direct current stimulation treatment for major depressive disorder: a fully remote phase 2 randomized sham-controlled trial. Nature Medicine, 31(1), 87-95.