Home Transcranial Direct Current Stimulation With Gamified Cognitive Control Training for Depression: A Randomized Clinical Trial.
20 affiliations
- 1Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Medizin, Ludwig-Maximilians-Universität München, Munich, Germany.
- 2DZPG (German Center for Mental Health), Partner Site Munich-Augsburg, Germany.
- 3Department of Statistics and Data Science, Faculty of Social Sciences, The Hebrew University of Jerusalem, Israel.
- 4Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Munich, Germany.
- 5Charlotte Fresenius Hochschule, Munich, Germany.
- 6Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia.
- 7National Centre of Mental Health, Riga, Latvia.
- 8Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
- 9School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Israel.
- 10Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland.
- 11Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, Valais, Clinique Romande de Réadaptation, Sion, Switzerland.
- 12Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
- 13Neuro@campusbiotech, Geneva, Switzerland.
- 14Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel.
- 15NeuroImaging Core Unit Munich, LMU University Hospital, Munich, Germany.
- 16Signal Processing Laboratory 5, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
- 17CIBM Center for Biomedical Imaging, Lausanne, Switzerland.
- 18Radiology Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
- 19Department of Psychiatry, Faculty of Medicine, The Hebrew University of Jerusalem, Israel.
- 20Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
Abstract
Importance
Transcranial direct current stimulation (tDCS) has emerged as a home-based treatment in major depressive disorder (MDD), although its effects are typically small to moderate and inconsistently observed. Because tDCS may act synergistically with behavioral interventions, combining both approaches represents a promising strategy for developing more effective home-based treatments for MDD.Objective
To investigate the feasibility, safety, and efficacy of home-based tDCS and concurrent gamified cognitive control training (CCT) in adults with MDD.Design, setting, and participants
This multicenter, double-masked, parallel-group, randomized clinical trial with follow-up at week 10, masking checks at 2 time points, and expectancy assessments was conducted at 3 university hospitals in Latvia, Germany, and Israel between June 22, 2021, and August 8, 2024. Participants included adults aged 18 to 65 years with MDD, 17-item Hamilton Depression Rating Scale scores of at least 13, and no or stable antidepressant medication.Intervention
Participants were randomly assigned 1:1 to active tDCS (2 mA; anode F3, cathode F4) plus a gamified CCT or sham tDCS plus a sham game. Participants were asked to complete 30 home treatment sessions (30 minutes each) over 6 weeks with software-assisted electrode positioning.Main outcomes and measures
The primary outcome was feasibility, defined as completing at least 20 of 30 sessions with greater than 50% probability. The secondary outcome was efficacy, measured as change in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline to week 6.Results
Of 111 enrolled participants, 109 were included in the modified intention-to-treat sample (55 in the active group and 54 in the control group; mean [SD] age, 33.1 [10.6] years; 69 female [63.3%]). Feasibility criteria were met, with 86 participants (78.9%) completing at least 20 sessions (lower bound of 1-sided 95% CI, 71.5%). The MADRS scores improved significantly in both groups at week 6, indicating insufficient evidence to reject the null hypothesis of no difference in the mean change in MADRS score from baseline to 6 weeks between the 2 treatment groups (difference, 0.89 [95% CI, -1.37 to 3.15]; P = .44; Cohen d, 0.10 [95% CI, -0.15 to 0.34]). Results were similar at follow-up (week 10). Adverse events were balanced between groups.Conclusions and relevance
This RCT of home-based tDCS combined with CCT in adults with MDD was feasible and safe but did not demonstrate superior efficacy over the control condition. Future studies should refine the mechanistic alignment between stimulation and cognitive interventions to optimize treatment effects.Trial registration
ClinicalTrials.gov Identifier: NCT04953208.
Related
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BibTeX
@article{dechantsreiter2026home,
title = {{Home Transcranial Direct Current Stimulation With Gamified Cognitive Control Training for Depression: A Randomized Clinical Trial.}},
author = {Esther Dechantsreiter and Frank Padberg and Yuval Benjamini and Stephan Goerigk and Linda Rubene-Kesele and Liene Konosonoka and Ulrike Vogelmann and Tamar Cohen and Naamah Lerner and Gerrit Burkhardt and Aldo Soldini and Fabienne Windel and Marios Fanourakis and Zeno Menestrina and Arthur Nguyen and Angela Pasqualotto and Takuya Morishita and Amir Dotan and Shira Ahissar and Alon Morash and Jonas Björklund and Lucia Bulubas and Daniel Keeser and Netta Assa and Rémy Gardier and Roser Viñals and Jean-Philippe Thiran and Ronen Segman and Omer Bonne and Amit Lotan and Friedhelm C Hummel and Elmars Rancans and Daphne Bavelier and Mor Nahum},
journal = {JAMA network open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.39400},
url = {https://europepmc.org/article/MED/42895746},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Home Transcranial Direct Current Stimulation With Gamified Cognitive Control Training for Depression: A Randomized Clinical Trial.
AU - Esther Dechantsreiter
AU - Frank Padberg
AU - Yuval Benjamini
AU - Stephan Goerigk
AU - Linda Rubene-Kesele
AU - Liene Konosonoka
AU - Ulrike Vogelmann
AU - Tamar Cohen
AU - Naamah Lerner
AU - Gerrit Burkhardt
AU - Aldo Soldini
AU - Fabienne Windel
AU - Marios Fanourakis
AU - Zeno Menestrina
AU - Arthur Nguyen
AU - Angela Pasqualotto
AU - Takuya Morishita
AU - Amir Dotan
AU - Shira Ahissar
AU - Alon Morash
AU - Jonas Björklund
AU - Lucia Bulubas
AU - Daniel Keeser
AU - Netta Assa
AU - Rémy Gardier
AU - Roser Viñals
AU - Jean-Philippe Thiran
AU - Ronen Segman
AU - Omer Bonne
AU - Amit Lotan
AU - Friedhelm C Hummel
AU - Elmars Rancans
AU - Daphne Bavelier
AU - Mor Nahum
PY - 2026
DA - 2026/10/01
JO - JAMA network open
DO - 10.1001/jamanetworkopen.2026.39400
UR - https://europepmc.org/article/MED/42895746
AB - Importance Transcranial direct current stimulation (tDCS) has emerged as a home-based treatment in major depressive disorder (MDD), although its effects are typically small to moderate and inconsistently observed. Because tDCS may act synergistically with behavioral interventions, combining both approaches represents a promising strategy for developing more effective home-based treatments for MDD.Objective To investigate the feasibility, safety, and efficacy of home-based tDCS and concurrent gamified cognitive control training (CCT) in adults with MDD.Design, setting, and participants This multicenter, double-masked, parallel-group, randomized clinical trial with follow-up at week 10, masking checks at 2 time points, and expectancy assessments was conducted at 3 university hospitals in Latvia, Germany, and Israel between June 22, 2021, and August 8, 2024. Participants included adults aged 18 to 65 years with MDD, 17-item Hamilton Depression Rating Scale scores of at least 13, and no or stable antidepressant medication.Intervention Participants were randomly assigned 1:1 to active tDCS (2 mA; anode F3, cathode F4) plus a gamified CCT or sham tDCS plus a sham game. Participants were asked to complete 30 home treatment sessions (30 minutes each) over 6 weeks with software-assisted electrode positioning.Main outcomes and measures The primary outcome was feasibility, defined as completing at least 20 of 30 sessions with greater than 50% probability. The secondary outcome was efficacy, measured as change in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline to week 6.Results Of 111 enrolled participants, 109 were included in the modified intention-to-treat sample (55 in the active group and 54 in the control group; mean [SD] age, 33.1 [10.6] years; 69 female [63.3%]). Feasibility criteria were met, with 86 participants (78.9%) completing at least 20 sessions (lower bound of 1-sided 95% CI, 71.5%). The MADRS scores improved significantly in both groups at week 6, indicating insufficient evidence to reject the null hypothesis of no difference in the mean change in MADRS score from baseline to 6 weeks between the 2 treatment groups (difference, 0.89 [95% CI, -1.37 to 3.15]; P = .44; Cohen d, 0.10 [95% CI, -0.15 to 0.34]). Results were similar at follow-up (week 10). Adverse events were balanced between groups.Conclusions and relevance This RCT of home-based tDCS combined with CCT in adults with MDD was feasible and safe but did not demonstrate superior efficacy over the control condition. Future studies should refine the mechanistic alignment between stimulation and cognitive interventions to optimize treatment effects.Trial registration ClinicalTrials.gov Identifier: NCT04953208.
SN - 2574-3805
ER -