Real-World Assessment of Transcranial Direct Current Stimulation (tDCS) Combined with Sertraline in the Treatment of Depression in Vietnam

Tinh Xuan Do,1 Huy Quang Bui,1 Hung Viet Dinh,1 Linh Van Nguyen,1 Thu Thi Pham,1 Dao Trong Nguyen,1 Dinh Tat Nguyen,1 Lang Ngoc Huynh,1 Toan Quoc Pham,2 Thao Ngoc Pham,3 Tuan Ngoc Tran,4 Xuan Thanh Nguyen5 1Department of Psychiatry, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam; 2Department of Nepherology and Dialysis, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam; 3Department of Functional Diagnosis, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam; 4Department of Community Health, Vietnam Military Medical University, Hanoi, Vietnam; 5Senior Officer Department, 103 Military Hospital, Vietnam Military Medical University, Hanoi, VietnamCorrespondence: Xuan Thanh Nguyen, Senior Officer Department, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam, Email [email protected]: Major depressive disorder (MDD) is a leading cause of disability worldwide. While selective serotonin reuptake inhibitors (SSRIs) such as Sertraline are widely used, a substantial proportion of patients achieve only partial remission. Transcranial direct current stimulation (tDCS), a non - invasive neuromodulation technique, has been approved and implemented as a clinical procedure in Vietnam. This study aimed to assess the real - world effectiveness of combining tDCS with Sertraline in patients with MDD.Methods: This open-label, randomized real-world study was conducted at 103 Military Hospital. A total of 140 inpatients with MDD were allocated to receive either Sertraline alone (n = 70) or Sertraline plus tDCS (n = 70) as part of routine care. Depression severity was evaluated using the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAMD), and serum serotonin levels were measured at baseline and after a three - week treatment period. Statistical analyses included repeated - measures ANOVA and ordinal logistic regression.Results: Both groups demonstrated significant reductions in BDI and HAMD scores over time (p < 0.001). However, the Sertraline + tDCS group exhibited a significantly greater increase in serum serotonin (+ 30.3 vs + 20.0 ng/mL, p < 0.0001) and greater symptom improvement. Logistic regression indicated a higher likelihood of clinical response in the tDCS group (BDI: OR ≈ 4.3, p = 0.032; HAMD: OR ≈ 6.5, p = 0.018).Conclusion: In a real - world clinical setting in Vietnam, adjunctive tDCS combined with Sertraline was associated with enhanced biological and clinical outcomes in MDD patients. These findings provide supportive evidence for the integration of tDCS into standard psychiatric care, although further controlled studies are warranted.Keywords: depression, sertraline, transcranial direct current stimulation, tDCS, serotonin, adjunctive therapy, real-world study