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

Background: 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.