Comparison of the Efficacy of Transcranial Direct Current Stimulation at Home Versus in Hospital Settings in Patients With Depressive Episodes

Inclusion criteria

• Men or women over the age of 18
• Psychiatric diagnosis:

• Presenting a depressive episode characterised according to DSM-5 criteria
• MADRS score greater than or equal to 20, indicating moderate to severe depression
• Indication and prescription of a course of tDCS treatment consisting of 20 sessions of 30 minutes at 2mA, at a rate of 2 sessions per day
• Drug treatment:

o Failure of a maximum of 1 or 2 antidepressants taken successively or in combination for the current episode

• Psychiatric follow-up: Receiving medical follow-up by a psychiatrist or referring physician
• Ability to understand and cooperate:

• Having a smartphone, computer or tablet (with internet connection and Bluetooth) to use the digital interface required to perform remote tDCS
• Be deemed capable of understanding the nature of the study and participating in clinical follow-up
• Informed consent: Have given written consent to participate in the research, after receiving oral and written information about the study.
• Social affiliation: Be affiliated with a social security system

Exclusion criteria

• Psychiatric or neurological diagnoses:

• Chronic psychotic disorders or history of schizophrenia
• Progressive neurological disorders (unstabilised epilepsy, brain tumour, recent stroke, severe head injury)
• History or current treatment of neuromodulation

• Any history of tDCS treatment, whether carried out in a clinical or research setting
• Current treatment or history of rTMS and ECT sessions for the current episode
• Presence of an active vagus nerve stimulation implant
• Presence of a high risk of suicide. A risk of suicide will be considered high if the score on item 10 of the MADRS scale ("Suicidal Thoughts") is 4 or higher, and/or if there is active suicidal ideation accompanied by clinically identified intent or a plan
• Addiction and substance use: Current substance use disorder other than nicotine or caffeine
• Psychiatric comorbidities that may interfere with study participation, including: understanding information, adherence to the protocol, and completing CBT sessions.
• Recent change in curative psychotropic treatment (antidepressant, mood stabiliser including lithium and anticonvulsants, mood-stabilising antipsychotic) in the month prior to inclusion.
• Medical contraindication to stimulation:

• Presence of a metallic or electronic implant in the skull or chest (pacemaker, neurostimulator, cochlear implant)
• Skin lesion, irritation or wound on the electrode contact areas
• History of epileptic seizures not related to an identified cause or not stabilised for more than 12 months
• Current pregnancy or breastfeeding
• Women of childbearing age without effective contraception (hormonal or medical device)
• A severe and/or progressive somatic condition requiring ongoing medical care that would interfere with participation in the study.
• Limited ability to participate:

• A significant cognitive impairment or sensory deficit that prevents understanding of instructions
• Inability to safely perform tDCS at home, as defined by at least one of the following:

• inability to understand or recall essential instructions regarding procedure and safety;
• inability to perform, following initial guidance, the essential steps for setting up and starting the device;
• lack of the minimum material conditions required at home to conduct the sessions.
• Special legal or social situation:

• Patients under guardianship, curatorship or judicial protection
• Privation of liberty by judicial or administrative decision, Presence of a functional limitation to the independent performance of tDCS