Subjective Health Perception Moderates the Antidepressant Effects of Home-Based Transcranial Direct Current Stimulation in Perinatal Women: A Real-World Observational Study

Abstract

Objective Perinatal depression often remains undertreated due to concerns about antidepressant exposure during fertility treatment, pregnancy, or breastfeeding. Non-pharmacological, home-based interventions such as transcranial direct current stimulation (tDCS) present a promising alternative; however, real-world evidence in perinatal populations remains limited. Methods This prospective observational study included 38 women who received infertility, pregnancy, or postpartum treatment at four hospitals in South Korea. Participants self-administered anodal tDCS targeting the left dorsolateral prefrontal cortex for 20-28 sessions over 4 weeks. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and weeks 2, 4, and 8. Subjective health perception was measured at baseline using a 5-point Likert scale. Results Time had a significant effect on depressive symptoms (Wald chi(2)=90.75, p<0.001), with the largest reduction observed during the first 2 weeks. The CES-D scores remained significantly lower than baseline at week 8, 4 weeks after treatment ended. Subjective health perception was significantly associated with baseline depression severity (Wald chi(2)=26.41, p<0.001), and its interaction with time was also significant (Wald chi(2)=320.18, p<0.001). Participants with poorer perceived health (scores 4-5) experienced greater depressive symptom reductions than those with more favorable perceptions (scores 1-2). Conclusion Home-based tDCS was feasible and associated with clinically meaningful improvement in depressive symptoms among perinatal women. Those who initially perceived their health more negatively showed greater response, suggesting subjective health perception may serve as a useful moderator and potential marker to inform personalized treatment strategies.