Clinical and Behavioral Outcomes During 4 Weeks of Home-Based Self-Administered Transcranial Direct Current Stimulation in Perinatal Women With Depressive Symptoms: Open-Label Exploratory Pilot Study

Abstract

Background: Depression during the perinatal period poses significant risks to both maternal and infant health. Although transcranial direct current stimulation (tDCS) has shown promise as a safe and well-tolerated intervention for perinatal depression, empirical evidence remains limited, and no prior study has integrated clinical outcomeswith continuous objective behavioral monitoring. Objective: This pilot study aimed to evaluate thefeasibility and preliminary effects of home-based tDCS combined with wearable monitoring in women with perinatal depression and to explore the correlation between behavioral and clinical measures. Methods: In total, 38 perinatal women completed a 4-week self-administered tDCS protocol targeting the left dorsolateral prefrontal cortex (DLPFC) with 30-minute daily sessions. Participants continuously wore a wrist device (Fitbit Inspire 2) that passively collected data on the step count, distance traveled, calorie expenditure, and heart rate. Depressive symptoms were assessed at baseline (week 0), midintervention (week 2), and postintervention (week 4) using the Montgomery-& Aring;sberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI). Linear mixed models (LMMs) and nonparametric tests were used to evaluate changes over time, and correlations between behavioral and clinical variables were analyzed. Results: Significant reductions were observed in depressive symptoms from baseline to postintervention. Mean MADRS scores decreased from 21.3 (SD 5.2) at baseline to 12.3 (SD 8.5) at week 4 (P<.001), and mean BDI scores decreased from 24.8 (SD 11.4) atbaselineto 16.1 (SD 11.2) atweek4 (P<.001). Physical activity markers increasedsignificantly: from baselinetoweek 4, the mean daily step count increased from 2366.8 (SD 2293.0) to 6278.7 (SD 5026.8) steps (P<.001), the mean distancetraveled daily increased from 1564.6 (SD 1528.4) to 4105.9 (SD 3117.6) m (P<.001), and the mean daily calorie expenditure increased from 1130.6 (SD 759.9) to 1834.9 (SD 458.1) kcal (P<.001). However, the mean resting heart rate decreased from 85.9 (SD 9.0) to 80.4 (SD 7.0) bpm (P<.01). Exploratory correlation analyses revealed that BDI score reductions, but not MADRS changes, correlated significantly with increases in physical activity indicators (step count: r=0.401, P=.02 at week 2; r=0.351, P=.04 at week 4). Conclusions: Results showed that 4 weeks of home-based, self-administered tDCS are feasible, well tolerated, and associated with improvements in depressive symptoms and objective behavioral activity among perinatal women. Self-reported symptom changes show stronger correlations with behavioral outcomes compared to clinician-rated scores. Although the lack of a control group precludes causal inference, these findings support the feasibility of integrating wearable monitoring with tDCS protocols and warrant further validation in randomized sham-controlled trials.