Personalized brain stimulation shows promise as fast-acting depression treatment

A more precise form of noninvasive brain stimulation, tailored to an individual’s brain structure, may offer a faster and more effective path to relief for people with moderate to major depression. A new study from UCLA Health suggests this personalized approach can reduce depressive symptoms in less than two weeks, with a notable portion of participants achieving remission. The findings, published in JAMA Network Open, point toward a potential new therapeutic option that is both well-tolerated and targeted at the specific brain circuits implicated in the disorder.

The researchers embarked on this study to address a persistent challenge in mental healthcare: the limitations of existing treatments for depression. While antidepressant medications and psychotherapies are effective for many, a substantial number of individuals do not respond to them, even after trying multiple options. These standard treatments can also take several weeks or even months to show a benefit and are sometimes accompanied by undesirable side effects, such as weight gain or sleep problems. This gap in care highlights a need for new therapies that are not only effective but also work quickly and have a favorable safety profile.

Scientific understanding of depression has evolved to view it not just as a chemical imbalance but as a condition involving disruptions in large-scale brain networks. Brain imaging studies have identified patterns of altered activity in circuits that manage emotional processing and self-related thoughts. Specifically, a network known as the frontoparietal network, which includes a region called the dorsolateral prefrontal cortex (DLPFC), often shows reduced activity on the left side of the brain. At the same time, networks associated with internal thoughts and emotional responses can become overactive.

A treatment called transcranial direct current stimulation, or tDCS, was developed to address this imbalance. It uses scalp electrodes to deliver a weak electrical current to nudge brain activity back toward a healthier state. However, conventional tDCS uses large electrodes that deliver a diffuse, unfocused current, which may not precisely stimulate the intended DLPFC target.

The researchers theorized that a newer, more focused method called high-definition tDCS (HD-tDCS), which uses a cluster of smaller electrodes, could be more effective by delivering a more concentrated electrical field to the exact target. Combined with personalization using MRI scans to pinpoint the target location for each participant, the team hypothesized that this approach would yield better clinical results.

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To test this hypothesis, the scientists designed a randomized, double-blind, sham-controlled clinical trial, which is considered a high standard for medical research. They recruited 71 adults between the ages of 18 and 65 who were currently experiencing a moderate to severe major depressive episode. Participants were randomly assigned to one of two groups. One group received the active, personalized HD-tDCS treatment. The other group received a sham, or placebo, treatment.

The “double-blind” aspect meant that neither the participants nor the researchers administering the treatment knew who was receiving the active or sham stimulation until the study concluded. This design helps prevent expectations from influencing the results.

Each participant underwent an MRI scan at the beginning of the study. This scan was used to create a 3D model of their brain, allowing the researchers to identify the exact coordinates of the left DLPFC target for each individual. For every treatment session, a specialized neuronavigation system guided the placement of the five small electrodes on the scalp to ensure precision.

The treatment course consisted of 12 daily sessions, each lasting 20 minutes, administered over consecutive workdays. The active group received a constant 2-milliamp current aimed at exciting the hypoactive left DLPFC. The sham group experienced a brief ramp-up and ramp-down of the current at the beginning and end of the session, creating a tingling sensation similar to the real treatment, but received only a negligible current for the remainder of the 20 minutes. The severity of participants’ depression was measured before, during, and after the treatment course using the Hamilton Depression Rating Scale (HAMD), a standard clinical assessment.

The results of the trial showed a clear benefit for the active treatment group. Participants who received the personalized HD-tDCS experienced a significantly greater reduction in their depression scores compared to those who received the sham stimulation. This improvement was not only statistically significant but also appeared rapidly. A noticeable difference between the two groups was already evident at the study’s midpoint, after just six treatment sessions. By the end of the 12 sessions, the average reduction in depression scores was substantially larger in the active group.

Beyond the general improvement in mood, the researchers looked at specific clinical milestones. They found that the rate of remission, defined as a reduction of symptoms to a point where a person is considered no longer clinically depressed, was significantly higher in the active treatment group. Nearly 40 percent of participants receiving personalized HD-tDCS achieved remission, compared to just over 13 percent in the sham group.

The rate of response, defined as at least a 50 percent reduction in symptoms, was also higher in the active group (42 percent versus 27 percent), although this particular difference did not reach statistical significance. An exploratory analysis also revealed that the treatment significantly improved anxiety symptoms, which frequently accompany depression. The intervention was well tolerated, with participants reporting only mild side effects like temporary skin redness or itching at the electrode sites.

Although the findings are promising, the researchers identified several limitations to their study. The trial was not designed to examine how HD-tDCS might interact with antidepressant medications, which many participants were taking. It is possible that the treatment’s effects could differ in people who are not on medication. The study’s follow-up period was also relatively short, and it did not include maintenance or “booster” sessions. While the benefits in the active group appeared stable at two and four weeks post-treatment, longer trials with maintenance protocols are needed to determine the durability of the positive effects.

Future research could also work to optimize the treatment protocol, perhaps by extending the number of sessions, as participants’ mood scores were still improving at the end of the 12-day course. Finally, a direct head-to-head comparison with conventional, less-focused tDCS would be necessary to definitively establish the superiority of the high-definition, personalized method. Such studies could confirm whether the enhanced precision is the key factor behind the promising results. Additional work could also explore the potential of this therapy for treating anxiety disorders, given the observed reduction in anxiety symptoms.

The study, “Personalized High-Definition Transcranial Direct Current Stimulation for the Treatment of Depression: A Randomized Clinical Trial,” was authored by Mayank A. Jog, Viviane Norris, Paloma Pfeiffer, Brandon Taraku, Suzanne Kozikowski, Jacquelyn Schneider, Michael Boucher, Marco Iacoboni, Roger Woods, and Katherine Narr.