At-home treatment of depression during Covid-19
The ongoing health crisis surrounding Covid-19 has caused uncertainty when it comes to treating patients. The importance of avoiding social contact to stop the spread of the virus means there may have to be limited accessibility to treatments like psychotherapy, ECT (electroconvulsive therapy) and rTMS (repetitive transcranial magnetic stimulation). For patients who rely on these treatments, an unplanned interruption can lead to negative health consequences. For this reason, any alternatives to provide remote treatment might be welcome.
What is tDCS?
Transcranial direct current stimulation (tDCS) is a neuromodulation technique used to treat a number of psychiatric and neurophysiological conditions. It uses a weak electric current, delivered to the brain from a usually small, portable device. The stimulation area depends on what condition is being treated.
In depression, the left DLPFC (dorsolateral prefrontal cortex) of the brain is hypoactive, while the right DLPFC is hyperactive. Therefore, when treating depression with tDCS, the anode (electrode with positive current) is placed over the left DLPFC and the cathode (electrode with negative current) is placed over the right DLPFC. The desired result is to achieve the left and right DLPFC balance and activity levels found in healthy individuals not suffering from depression.
The use of tDCS to treat depression has been established as both effective (read the latest meta-analysis here) and safe (read a large safety review here). tDCS is well-tolerated by patients and causes no serious side effects. It is important to note that the effects of tDCS are accumulative: the patient will not feel any effect until they have undergone at least a number of sessions, and so it is important to continue treatment to enable a response.
What is Sooma Depression therapy?
Sooma depression therapy is an effective treatment for depression. It utilises the method tDCS and is given using our class II medical device, Sooma tDCS. To direct the electric current (2 mA) from the device to the brain, Sooma depression therapy uses the following accessories: a headcap, electrodes, gel pads, and conductive medium.
The Sooma headcap ensures that the correct areas of the brain are stimulated during each and every treatment session. The two electrodes consist of two electrode cups and a set of cables; one gel pad soaked in saline solution (the conductive medium) is placed in each electrode cup and fastened in the headcap. The cables connect to the device.
Sooma depression therapy normally utilises a three-week treatment protocol during acute treatment. Each treatment session is 30 minutes long and is given 5 times per week (for example Mondays through Fridays). This is followed by a maintenance period, where treatment sessions can be given 1-2 times per week for a time, depending on the response of each individual patient. The number of treatment sessions and weeks during the acute treatment period can also be modified to fit each individual patient.
The latest treatment results for Sooma depression therapy (2019) are based on 302 patients who underwent depression treatment with Sooma tDCS. The results show a 61% response rate, meaning 61 out of 100 patients have reported a ≥50% drop in depressive symptoms after having undergone the treatment. For remission, the rate is 20%, meaning 1 out of 5 patients no longer had any symptoms of depression after having undergone treatment. Read more about the treatment results in our White paper.
Sooma depression therapy can be used as a monotherapy or alongside other simultaneous treatments, such as psychotherapy or pharmaceuticals. It can also be used to maintain the treatment response achieved after treatment with ECT or rTMS; the patient completes acute treatment with ECT or rTMS and is then given Sooma depression therapy for a period of time to maintain the response, either by visiting the clinic or self-administering the treatment at home.
What makes Sooma Depression Therapy an ideal home-based treatment?
Sooma depression therapy is designed from the start to be suitable for home-based treatment. The device and equipment are small and easy to transport. The therapy itself is easy to apply and takes only takes about five minutes to prepare. The device features a single button to make starting the therapy easy, and turns itself off automatically at the end of the session, which prevents any accidental overuse.
With Sooma depression therapy, patients can borrow the device and accessories and self-administer the treatment themselves at home. This way, patients do not need to come to the hospital or clinic for treatment sessions, saving the time of clinicians and nurses along with other resources.
In order to ensure that the patient is following the treatment schedule, the healthcare provider can use our cloud-based platform. It consists of an online portal, where healthcare providers can monitor their patients’ progress and compliance, and a mobile app, where patients register their administration of the therapy. Alternatively, the healthcare provider can utilise weekly calls or text messages to follow up on patient progress and compliance instead.
During Covid-19, Sooma depression therapy is a good treatment alternative for patients suffering from depression not only because it is an effective and safe treatment, but also because it can be done completely remotely. The treatment can be started, applied, supervised, and completed without any physical contact between the healthcare provider and patient whatsoever.
During Covid-19, home-based Sooma depression therapy can be started as an acute treatment but can also be used to treat patients during interruptions in treatments with ECT, rTMS, or psychotherapy. The aim is to retain any response to the treatment that these patients may have been experiencing before the interruption, and to be able to offer relief for these patients during the ongoing health crisis.
How to start with Sooma Depression Therapy: practical steps (with Covid-19 adaptations)
Normally, the first meeting with the patient would be conducted in the clinic, but during Covid-19, the following steps can be conducted over the phone or over video call.
1. Gather the relevant information about the patient, such as health history, medications, and contact details.
2. Make sure that the patient is eligible for the treatment by checking that they do not have any of the three contraindications: metal implants in the skull, pacemaker, or eczema in the stimulation area.
3. Determine the patient’s baseline depression score using the depression scale of your choice (for example BDI, HAMD, MADRS). The form can be sent to the patient to be filled out, and the answers recited to the clinician.
4. Go through the loaner agreement and make sure the patient has signed it before being given the equipment.
5. Lend the device and accessories to the patient. Make sure the patient receives one device, one head cap (ask the patient to measure their head circumference and pick out the correct size), one pair of electrode cups, one set of cables, and enough disposable pads and saline solution to last for the planned treatment period. During Covid-19, arrange for the equipment to be sent to the patient’s home address, or arrange for the patient to pick the equipment up with as little contact as possible.
Normally, the first treatment session would be conducted in the clinic and be administered by a nurse while simultaneously serving as an instruction for the patient on how to self-administer the treatment. But during Covid-19, the following steps can be conducted over the phone or over video call.
1. Make sure the patient has relevant instructions and materials for the treatment period. Sooma will provide you with both written instructions and video instructions for the patient on how to administer the treatment.
2. Ideally, observe the patients’ preparation and self-administration of the first treatment session over a video call, in order to make sure that they are doing it correctly.
1. During Covid-19, we recommend the following treatment protocol: 1 session per day for 6 weeks (30 sessions) + optional 10 weeks (30 sessions). Every session to consist of 2mA for 30 minutes.
2. Week 1-5: Have a weekly phone call or text with the patient, and a weekly check on the online portal if using the software platform.
3. Week 6: Call or text the patient to evaluate the results. Have them fill out a BDI/MADRS/HAMD form for an assessment of their new depression score. Decide on whether to continue the treatment, if yes, supply them with more disposables, if no, have the patient return the equipment. During Covid-19, make sure to disinfect the device before lending it to the next patient.
The Sooma Team is here to support you remotely with any questions or issues that you might have.
We also have many resources available for you, such as patient screening forms (for contraindications), patient communication and marketing materials (brochure, instructions etc.), YouTube training videos, a software platform (healthcare provider portal and mobile application), loan agreement templates and much more, to make it as easy as possible for you start treating patients with home-based Sooma depression therapy.
Make sure to contact us should you be interested in Sooma depression therapy. You can write us at firstname.lastname@example.org, call us at +358 10 328 9811, or use this form.
Thank you for reading, and stay safe out there!