Spaced Transcranial Direct Current Stimulation for Treatment-Resistant Depression: A Home-Based Feasibility and Safety Study

Inclusion criteria

• People between the ages of 18 and 85 at the time of screening.
• Currently diagnosed with Major Depressive Disorder (MDD) as measured by the MINI and a MADRS score of ≥ 20.
• Safe for TMS as measures by the TMS Adult Safety Screening (TASS).
• Medical records confirming a history of failing to achieve clinical response to an adequate antidepressant trial as defined an Antidepressant Treatment History Form (ATHF) score ≥ 3 or ) or shown intolerance to at least two inadequate trials (score 1 or 2), without psychiatric illness due to a general medical condition.
• Stable internet connection and a device compatible with Microsoft Teams.

Exclusion criteria

• History of psychotic or bipolar disorder or depression with psychotic features;
• Significant borderline personality disorder;
• Significant comorbid obsessive-compulsive or post-traumatic stress:
• Current moderate or severe substance use disorder or demonstrating signs of acute substance withdrawal;
• Clinically significant suicidality disorder;
• Chronic depression (defined as of over 5 years duration);
• Pregnancy or lactation, lack of adequate birth control in women of childbearing age;
• History of significant neurologic disease, including dementia, Parkinson's or Huntington's disease, brain tumor, seizure disorder, subdural hematoma, multiple sclerosis, or history of significant head trauma with persistent symptoms;
• Unstable medical illness;
• Contraindication to receiving tDCS (e.g., ferromagnetic implant, history of seizure, known brain lesion);
• History of TMS (greater than 15 sessions) without a clinically meaningful response.; History of ketamine (greater than 4 sessions) without a clinically meaningful response;
• Require a benzodiazepine with a dose > lorazepam 2 mg/day;
• dermatological conditions contraindicating tDCS;
• Non-correctable sensory impairments;
• Inability to consent or participate as an outpatient