Brain stimulation moves the needle right after treatment — but benefits fade fast
STUDY: Moshfeghinia R et al, Journal of Affective Disorders 2026; doi:10.1016/j.jad.2026.121739
STUDY TYPE: Systematic review and meta-analysis
FUNDING: Independent
Background
In 2026, the FDA approved an at-home transcranial direct current stimulation device (tDCS), Flow, for depression. The approval specified it was not for treatment resistant depression, but does it have any hope of working when two or more antidepressants have failed?
The Study
Six sham-controlled randomized trials (200 participants total) were pooled to examine tDCS in adults who hadn’t responded to at least two antidepressant trials. Another four studies provided 30-day follow-up data.
Active tDCS reduced depression significantly at end of treatment, with a medium-to-large effect. But at 30-day follow-up — the only durability data available — the difference between active and sham completely vanished (effect size 0.12). Adverse events were mild: scalp tingling, redness, occasional headache. One participant had worsened suicidal ideation as tDCS was tapered.
Limitations: Other meta-analyses have found little or no difference with tDCS in treatment resistant cases, even in the short-term. These are small trials with high heterogeneity (I² = 78%), inconsistent protocols, and a sham condition that may itself have biological effects.
Practice Implications
- tDCS does not work reliably in treatment resistant depression
- Whether continuing tDCS longer address the problem is not known — we lack maintenance data
- Among neuromodulation therapies, TMS, ECT, and ProLivRx (another at-home device) have better evidence in treatment resistant cases
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
What’s Your Take? Share in Comments
- Have you seen tDCS in treatment resistant depression?
- Have you seen people use tDCS long-term?
