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

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

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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 .

Original language	English
Article number	549
Journal	BMC Psychiatry
Volume	25
Issue number	1
Early online date	26 May 2025
DOIs	https://doi.org/10.1186/s12888-025-06948-4
Publication status	E-pub ahead of print - 26 May 2025

Keywords

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

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

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 = "Humans, Bipolar Disorder/therapy, Female, Transcranial Direct Current Stimulation/methods, Male, Middle Aged, Adult, Patient Acceptance of Health Care/psychology",

author = "Hakimeh Rezaei and Woodham, {Rachel D} and Ali-Reza Ghazi-Noori and Philipp Ritter and Michael Bauer and Young, {Allan H.} and Elvira Bramon and Fu, {Cynthia H. Y.}",

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year = "2025",

month = may,

day = "26",

doi = "10.1186/s12888-025-06948-4",

language = "English",

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T1 - Acceptability of home-based transcranial direct current stimulation (tDCS) in bipolar depression

T2 - thematic analysis of individual views

AU - Rezaei, Hakimeh

AU - Woodham, Rachel D

AU - Ghazi-Noori, Ali-Reza

AU - Ritter, Philipp

AU - Bauer, Michael

AU - Young, Allan H.

AU - Bramon, Elvira

AU - Fu, Cynthia H. Y.

N1 - Publisher Copyright: © The Author(s) 2025.

PY - 2025/5/26

Y1 - 2025/5/26

N2 - 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 .

AB - 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 .

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KW - Bipolar Disorder/therapy

KW - Female

KW - Transcranial Direct Current Stimulation/methods

KW - Male

KW - Middle Aged

KW - Adult

KW - Patient Acceptance of Health Care/psychology

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DO - 10.1186/s12888-025-06948-4

M3 - Article

C2 - 40321750

SN - 1471-244X

VL - 25

JO - BMC Psychiatry

JF - BMC Psychiatry

IS - 1

M1 - 549

ER -

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

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