Acceptability of home-based transcranial direct current stimulation (tDCS) in bipolar depression: thematic analysis of individual views

Hakimeh Rezaei; Rachel D Woodham; Ali-Reza Ghazi-Noori; Philipp Ritter; Michael Bauer; Allan H Young; Elvira Bramon; Cynthia H Y Fu

doi:10.1186/s12888-025-06948-4

Acceptability of home-based transcranial direct current stimulation (tDCS) in bipolar depression: thematic analysis of individual views

BMC Psychiatry. 2025 May 26;25(1):549. doi: 10.1186/s12888-025-06948-4.

Authors

Hakimeh Rezaei^{1

2

3}, Rachel D Woodham⁴, Ali-Reza Ghazi-Noori⁴, Philipp Ritter^{5

6}, Michael Bauer⁵, Allan H Young^{6

7

8}, Elvira Bramon⁹, Cynthia H Y Fu^{10

11

12}

Affiliations

¹ Department of Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany. hakimeh.rezayi@gmail.com.
² Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. hakimeh.rezayi@gmail.com.
³ Department of Psychology, University of East London, London, UK. hakimeh.rezayi@gmail.com.
⁴ Department of Psychology, University of East London, London, UK.
⁵ Department of Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
⁶ Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁷ National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, London, UK.
⁸ South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.
⁹ Department of Psychiatry, University College London, London, UK.
¹⁰ Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. cynthia.fu@kcl.ac.uk.
¹¹ Department of Psychology, University of East London, London, UK. cynthia.fu@kcl.ac.uk.
¹² National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, London, UK. cynthia.fu@kcl.ac.uk.

Abstract

Background: Acceptability is a multifaceted concept that reflects how a treatment is viewed, which impacts patient engagement, adherence, and provider implementation. Transcranial direct current stimulation (tDCS) is emerging as a novel non-invasive treatment for bipolar depression. We developed a home-based protocol for tDCS, which has demonstrated efficacy in unipolar and bipolar depression. We sought to explore the acceptability of home-based tDCS in bipolar depression.

Methods: Participants were 35 adults (26 women) with bipolar disorder (mean age 47.37 years, SD ± 13.78) in a current depressive episode of at least moderate severity. tDCS was provided in a bifrontal montage, 2 mA for 30 min each session, over 6 weeks with real-time supervision. Acceptability was assessed in a questionnaire and individual interviews, conducted at two timepoints: baseline and post treatment. Individual interviews were analysed by thematic analysis.

Results: Six main themes were found: helpfulness, side effects, burden, gratitude, ethicality and comparison to medications. The themes of gratitude and comparison with medications were novel in this group compared to unipolar depression.

Conclusion: Themes reflected high acceptability of tDCS treatment in bipolar depression and indicated strong interest in novel treatments in this population. Qualitative analysis can provide novel insights into individual experiences, understand barriers to treatment, and offer guidance for improving clinical treatments.

Trial registration: ClinicalTrials.gov: NCT05436613 registered on 23 June 2022 https// www.

Clinicaltrials: gov/study/NCT05436613 .

Keywords: Acceptability; Home-based treatment, bipolar depression; Qualitative analysis; Thematic analysis; Transcranial direct current stimulation.

Publication types

Clinical Study

MeSH terms

Adult
Bipolar Disorder* / psychology
Bipolar Disorder* / therapy
Female
Humans
Male
Middle Aged
Patient Acceptance of Health Care* / psychology
Transcranial Direct Current Stimulation* / adverse effects
Transcranial Direct Current Stimulation* / methods
Transcranial Direct Current Stimulation* / psychology

Associated data

ClinicalTrials.gov/NCT05436613

Grants and funding

R01 MH134236/MH/NIMH NIH HHS/United States