Transcranial stimulation with a video game: does it work for depression?

What is transcranial direct current stimulation

Transcranial direct current stimulation (tDCS) is a technique that passes a very weak electric current, of a few milliamperes, between two electrodes placed on the head. It does not cause seizures and does not require anesthesia, unlike electroconvulsive therapy, and it does not use magnetic fields, unlike transcranial magnetic stimulation. The current does not make neurons “fire”, but slightly changes their excitability: under the positive electrode, called the anode, nerve cells become a little more ready to activate.

In depression the anode is usually placed over the left dorsolateral prefrontal cortex, an area that tends to be less active in people with depression. The device is small and portable, and for this reason the possibility of using it at home, with remote supervision by a specialist center, has been studied for some years.

Why it is in the news now

The results of tDCS in depression have been mixed. A 2025 meta-analysis of 88 randomized trials found a benefit in patients with depression associated with other illnesses, but no significant reduction in symptoms in major depression alone, with low-quality evidence. A 2025 study, conducted entirely remotely on 174 patients, had instead given a positive result with ten weeks of home stimulation.

The idea behind the new study is simple: if the current makes neurons more ready to activate, perhaps it works better while the brain is working. For this reason the researchers combined stimulation with a video game that trains cognitive control, that is, the ability to concentrate, to inhibit automatic responses and to switch from one task to another, functions that are often weakened in depression.

How the study was conducted

The study took place in three university hospitals, in Riga (Latvia), Munich (Germany) and Jerusalem (Israel), between 2021 and 2024. It enrolled 111 adults aged 18 to 65 with major depression, who were either not taking antidepressants or were taking them at a stable dose; 109 of them were included in the main analysis, with a mean age of 33 years.

The participants were randomly divided into two groups:

• active group: real stimulation at 2 milliamperes for 30 minutes, with the anode on the left and the cathode on the right of the forehead, while they played an action video game with working memory, flexibility and planning tasks, which became harder as the patient improved;
• control group: sham stimulation, which switched on only for a few seconds at the beginning and at the end to give the same sensation on the skin, and a game that looked similar but was slow and undemanding.

The program included 30 sessions over 6 weeks, one for each weekday. The first sessions took place in hospital, the others at home, with software that helped to position the electrodes correctly and with remote monitoring of the stimulation parameters. Neither the patients nor the assessors knew who was receiving the real treatment.

The main objective was feasibility: to find out whether patients managed to complete at least 20 of the 30 sessions. Efficacy, measured with the Montgomery-Åsberg Depression Rating Scale (MADRS), a clinical scale for the severity of depression, was a secondary objective.

The results: transcranial direct current stimulation and depression

Feasibility and safety

The home program worked: 78.9% of patients completed at least 20 sessions (85.5% in the active group, 72.2% in the control group), and almost 90% of the sessions started were completed. Side effects were similar in the two groups (56.1% versus 61.1%). There were two serious events, both in the active group, one hospital admission for suicidal thoughts and one for worsening depression, which the authors judged probably unrelated to the treatment.

Efficacy

After 6 weeks, depression had improved in both groups, but to practically the same extent: the MADRS score fell by about 7 points with real stimulation and by about 8 points with sham stimulation, a non-significant difference. The result did not change at the follow-up visit in week ten. Response and remission rates, remission meaning that symptoms almost disappear, were actually lower in the active group (remission 20.4% versus 43.5%), although the authors urge caution in interpreting these figures because they do not take account of differences at baseline. Tests of cognitive function also showed no differences.

An interesting finding concerns expectations: patients convinced they had received the sham treatment improved less, regardless of what they had actually received.

Why it did not work

The authors propose an explanation: the video game in the active group was demanding, and patients in that group reported more pressure and a lower sense of being capable. A high mental and emotional load may have cancelled out the effect of stimulation instead of enhancing it. Other studies that combined tDCS with psychotherapy or digital interventions have given negative results, and the 2025 meta-analysis found no benefit from combining it with psychotherapy, while it did find a benefit from combining it with antidepressant medication.

There is also a design issue: the study compared the combination “stimulation plus game” with “sham stimulation plus sham game”, so it does not show which of the two components mattered more. The authors conclude that the results do not support the use of this approach in clinical practice in its current form.

What it means for the patient

To patients who ask me about brain stimulation devices to use at home, I explain that today the honest answer is “it depends on how and for whom”. This study shows that a well-organized home treatment is safe and that most patients manage to follow it; it does not show, however, that adding a cognitive video game improves results, and in fact it suggests the opposite.

Some practical points:

• tDCS does not replace treatment for depression: medication and psychotherapy remain the standard, and the best evidence for tDCS concerns precisely its combination with antidepressants;
• avoid do-it-yourself use: in the studies the device was used with precise protocols and under the supervision of a clinical center; devices bought online without medical advice do not offer the same guarantees;
• bipolar disorder calls for particular caution: in an earlier study two patients treated with tDCS had a manic episode (see also our article on bipolar disorder);
• anyone who gets worse or has suicidal thoughts should contact their doctor immediately or call 911 (US) or 999 (UK), whatever treatment they are following.

Message for doctors

Randomized, double-blind, multicenter trial with 109 patients in the main analysis: primary feasibility endpoint met (78.9% with at least 20 of 30 sessions), no superiority of home tDCS (2 mA, F3 anode/F4 cathode, 30 sessions over 6 weeks) combined with gamified cognitive training over control (MADRS difference 0.89; 95% CI −1.37 to 3.15; Cohen's d 0.10). The design does not separate the contributions of stimulation and game, follow-up is short (10 weeks) and the control group still received a game. The finding consistent with the 2025 meta-analysis is that combining tDCS with psychological or digital interventions has so far shown no benefit, whereas combining it with medication has. Home tDCS remains an option for clinical trials or specialist centers, not a routine therapy.

References

1. Dechantsreiter E, Padberg F, Benjamini Y, Goerigk S, Rubene-Kesele L, Konosonoka L, Vogelmann U, et al. Home Transcranial Direct Current Stimulation With Gamified Cognitive Control Training for Depression: A Randomized Clinical Trial. JAMA Network Open. 2026;9(10):e2639400. doi:10.1001/jamanetworkopen.2026.39400. PubMed
2. Ren C, Pagali SR, Wang Z, Kung S, Boyapati RB, Islam K, Li JW, et al. Transcranial Electrical Stimulation in Treatment of Depression: A Systematic Review and Meta-Analysis. JAMA Network Open. 2025;8(6):e2516459. doi:10.1001/jamanetworkopen.2025.16459. PubMed
3. Woodham RD, Selvaraj S, Lajmi N, Hobday H, Sheehan G, Ghazi-Noori AR, Lagerberg PJ, et al. Home-based transcranial direct current stimulation treatment for major depressive disorder: a fully remote phase 2 randomized sham-controlled trial. Nature Medicine. 2025;31(1):87-95. doi:10.1038/s41591-024-03305-y. PubMed
4. Brunoni AR, Moffa AH, Sampaio-Junior B, Borrione L, Moreno ML, Fernandes RA, Veronezi BP, et al. Trial of Electrical Direct-Current Therapy versus Escitalopram for Depression. The New England Journal of Medicine. 2017;376(26):2523-2533. doi:10.1056/NEJMoa1612999. PubMed
5. National Institute of Mental Health (NIMH), National Institutes of Health. Help for Mental Illnesses, last reviewed April 2026. Accessed 21 October 2026. nimh.nih.gov
6. NHS. Where to get urgent help for mental health, page last reviewed 26 April 2023. Accessed 21 October 2026. nhs.uk