HOME-ADMINISTERED TRANSCRANIAL DIRECT CURRENT STIMULATION WITH ASYNCHRONOUS REMOTE SUPERVISION IN THE TREATMENT OF DEPRESSION: FEASIBILITY, TOLERABILITY, AND CLINICAL EFFECTIVENESS

Background: Depression is linked to subtle disturbances in cardiac autonomic regulation and sleep.This study examines the impact of repetitive transcranial magnetic stimulation (rTMS) therapy on autonomic responses, as indicated by heart rate variability (HRV), and on sleep quality in patients with depression.Methods: In this study, 29 patients diagnosed with major depression according to DSM-5 criteria were enrolled.The severity of their depression was assessed using the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS).To measure heart rate variability (HRV) and evaluate sleep quality, 5-minute ECG rhythm strips were utilized, along with sleep questionnaires.Each patient underwent 10 sessions of 10Hz repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC).Results: Following rTMS treatment, patients experienced significant improvement in depression, as evidenced by a decrease in BDI scores from 32.4317.14 to 13.909.85(p<0.001) and in HAMD21 scores from 28.7211.06 to 14.7810.54(p<0.001).Additionally, there was a notable change in autonomic nervous system function, demonstrated by improvements in HRV indices: ANS improved from -1.271.07 to -0.381.08 (p=0.006),SDNN increased from 21.410.3 to 26.2410.78(p=0.020),SD from 20.9210.65 to 26.010.91(p=0.019),TP from 480.73669.96 to 731.58642.54(p=0.030),VL from 190.42136.72 to 347.42 327.53 (p=0.008), and LF from 94.92126.14 to 192.39 196.33 (p=0.011).Sleep quality also showed significant improvement, with scores decreasing from 13.333.74to 10.333.40(p=0.002).Conclusions: rTMS treatment significantly reduced depression severity, evidenced by decreases in BDI and HAMD21 scores, improved heart rate variability indices, and enhanced sleep quality in patients.