ELECTROTHERAPY AND NEUROMODULATION MODALITIES IN MODERN PSYCHIATRY
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6624Keywords:
Electrotherapy, Neuromodulation, Electroconvulsive Therapy, Transcranial Direct Current Stimulation, Transcutaneous Vagus Nerve Stimulation, Treatment-Resistant Depression, Neuroplasticity, Tele-PsychiatryAbstract
Psychiatric disorders, led by major depressive disorder, bipolar affective disorder, treatment-resistant depression (TRD), and severe anxiety spectrum conditions, constitute a foremost contributor to global disease burden and societal disability. While monoaminergic psychopharmacology and evidence-based psychotherapies remain foundational therapeutic pillars, up to one-third of clinical cohorts fail to achieve functional remission, presenting with persistent chronicity, pharmacoresistance, and debilitating side-effect profiles. Electrotherapy and bioelectrical neuromodulation have re-emerged as critical, biologically targeted interventions capable of directly modulating aberrant neural circuitry and network dysconnectivity. This comprehensive review synthesizes empirical and technological developments (2019–2026) across the spectrum of psychiatric brain stimulation modalities. We evaluate hospital-based interventions—specifically the refinement of Electroconvulsive Therapy (ECT) through ultra-brief pulse paradigms and cognitive-sparing geometries—alongside non-invasive transcranial electrical stimulation (tES) modalities, including transcranial Direct Current Stimulation (tDCS), transcranial Alternating Current Stimulation (tACS), and transcranial Random Noise Stimulation (tRNS). Furthermore, we examine peripheral neuromodulation via transcutaneous auricular Vagus Nerve Stimulation (taVNS), the synergistic integration of neurostimulation with Cognitive Behavioral Therapy (neural priming), and the decentralization of care toward home-based, remotely monitored tele-tDCS platforms. By evaluating neurobiological mechanisms, synaptic plasticity, health economics, regulatory hurdles, and persistent societal stigma, this review demonstrates that modern electrotherapy represents a precise, scalable, and indispensable domain in contemporary interdisciplinary psychiatry.
References
Abbott, C. C., Argyelan, M., Kellner, C. H., McClintock, S. M., Narayana, S., Petrides, G., Quinn, D., Upston, J., & Vaidya, P. V. (2021). Neuroimaging mechanisms of electroconvulsive therapy in treatment-resistant depression: A systematic review. The American Journal of Psychiatry, 178(9), 808–820. https://doi.org/10.1176/appi.ajp.2020.20081254
Alonzo, A., Fong, J., Ball, N., Sachdev, P., & Loo, C. (2019). Feasibility and safety of at-home transcranial direct current stimulation (tDCS) for the treatment of depression: A open-label pilot study. Journal of Affective Disorders, 253, 303–309. https://doi.org/10.1016/j.jad.2019.04.085
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787
Antal, A., Alekseichuk, I., Bikson, M., Brockmöller, J., Brunoni, A. R., Chen, R., Cohen, L. G., Dowthwaite, J. N., Ellrich, J., Flöel, A., Fregni, F., George, M. S., Hamilton, R., Haueisen, J., Herrmann, C. S., Hummel, F. C., Lefaucheur, J. P., Liebetanz, D., Loo, C. K., ... Paulus, W. (2017). Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines. Clinical Neurophysiology, 128(9), 1774–1809. https://doi.org/10.1016/j.clinph.2017.06.001
Badran, B. W., Mithoefer, O. J., Summering, C. E., LaBate, N. T., Glusman, C. E., Badran, A. W., DeVries, W. H., Summers, P. M., Austelle, C. W., McTeague, L. M., Borckardt, J. J., & George, M. S. (2018). Short trains of transcutaneous auricular vagus nerve stimulation (taVNS) have parameter-specific effects on heart rate. Brain Stimulation, 11(4), 699–708. https://doi.org/10.1016/j.brs.2018.04.004
Bajbouj, M., Aust, S., Spies, J., Herrera-Melendez, A. L., Mayer, S. V., Peters, M., Plewnia, C., Fallgatter, A. J., Fritsch, B., Schoisswohl, S., & Langguth, B. (2018). Psychotherapy-augmented transcranial direct current stimulation in treatment-resistant depression: A randomized, double-blind, sham-controlled trial. Brain Stimulation, 11(4), 882–883. https://doi.org/10.1016/j.brs.2018.04.015
Bandelow, B., Allgulander, C., Baldwin, D. S., Costa, D. L. C., Denys, D., Dilbaz, N., Domschke, K., Fineberg, N. A., Gloster, A. T., Kessler, R. C., Menchón, J. M., Miguel, E. C., Möller, H. J., Rickels, K., Rief, W., Stein, D. J., & Zohar, J. (2023). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part I: Anxiety disorders. The World Journal of Biological Psychiatry, 24(2), 79–117. https://doi.org/10.1080/15622975.2022.2086295
Bergmann, T. O., Karabanov, A., Hartwigsen, G., Thielscher, A., & Siebner, H. R. (2016). Combining non-invasive transcranial brain stimulation with neuroimaging and electrophysiology: Current approaches and future perspectives. NeuroImage, 140, 4–19. https://doi.org/10.1016/j.neuroimage.2016.02.012
Bikson, M., Name, A., & Rahman, A. (2013). Cellular properties of transcranial direct current stimulation. In C. Miniussi, W. Paulus, & P. M. Rossini (Eds.), Transcranial brain stimulation (pp. 55–92). CRC Press.
Bikson, M., Grossman, P., Thomas, C., Zannou, A. L., Jiang, J., Adnan, T., Mourdoukoutas, A. P., Kronberg, G., Truong, D., Boggio, P., Brunoni, A. R., Charvet, L., Fregni, F., & Loo, C. (2016). Safety of transcranial direct current stimulation: Evidence based update 2016. Brain Stimulation, 9(5), 641–661. https://doi.org/10.1016/j.brs.2016.06.004
Bikson, M., Brunoni, A. R., Charvet, L. E., Clark, V. P., Cohen, L. G., Deng, Z. D., Dmochowski, J., Edwards, D. J., Fonregne, A., Fritsch, B., Gandiga, P., Hamner, M., Knotkova, H., Lisanby, S. H., Loo, C., Mantovani, A., Malcolm, M. P., Nitsche, M. A., Pascual-Leone, A., ... Fregni, F. (2018). Rigor and reproducibility in research with transcranial electrical stimulation: An NIMH-sponsored workshop. Brain Stimulation, 11(3), 465–480. https://doi.org/10.1016/j.brs.2017.12.008
Bikson, M., Paneri, B., Mourdoukoutas, A., Esmaeilpour, Z., Badran, B. W., & Charvet, L. E. (2020). Rigor in remotely supervised transcranial electrical stimulation (RS-tES) trials: A systematic review. Brain Stimulation, 13(4), 1070–1081. https://doi.org/10.1016/j.brs.2020.04.016
Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacios, A., & Baños, R. (2017). Recent progress in virtual reality exposure therapy for phobias: A systematic review. Current Psychiatry Reports, 19(7), 40. https://doi.org/10.1007/s11920-017-0788-4
Brunoni, A. R., Sampaio-Junior, B., Moffa, A. H., Aparício, L. V., Gordon, P., Klein, I., Razza, L. B., Kuo, M. F., Benseñor, I. M., Lotufo, P. A., & Nitsche, M. A. (2017a). Noninvasive brain stimulation in psychiatric disorders: A primer. Brazilian Journal of Psychiatry, 41(1), 70–81. https://doi.org/10.1590/1516-4446-2017-0018
Brunoni, A. R., Moffa, A. H., Sampaio-Junior, B., Borrione, L., Moreno, M. L., Fernandes, R. A., Veronezi, B. P., Nogueira, B. S., Aparicio, L. V., Razza, L. B., Chammas, R., Fraguas, R., Santos, I. S., Chao, M. V., & Fregni, F. (2017b). Trial of electrical direct-current therapy versus escitalopram for depression. The New England Journal of Medicine, 376(26), 2523–2533. https://doi.org/10.1056/NEJMoa1612999
Cates, H. M., Sunder, K., & George, M. S. (2021). Combining transcranial electrical stimulation with cognitive training in psychiatric populations: A systematic review of synergistic paradigms. Journal of Affective Disorders, 282, 1024–1035. https://doi.org/10.1016/j.jad.2020.12.189
Chakrabarti, S. (2020). Socio-economic and ethical issues in electroconvulsive therapy: An update. World Journal of Psychiatry, 10(9), 200–213. https://doi.org/10.5498/wjp.v10.i9.200
Charvet, L. E., Dobbs, B., Shaw, M. T., Bikson, M., Datta, A., & Krupp, L. B. (2020). Remotely supervised transcranial direct current stimulation (RS-tDCS) for clinical trials: Guidelines for design and implementation. Frontiers in Human Neuroscience, 14, 570624. https://doi.org/10.3389/fnhum.2020.570624
Dedoncker, J., Brunoni, A. R., Baeken, C., & Vanderhasselt, M. A. (2016). A systematic review and meta-analysis of the effects of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex on cognitive functioning in healthy and psychiatric populations. Neuroscience & Biobehavioral Reviews, 69, 109–127. https://doi.org/10.1016/j.neubiorev.2016.07.016
Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes (4th ed.). Oxford University Press.
Fang, J., Rong, P., Hong, Y., Fan, Y., Liu, J., Wang, H., Zhang, G., Chen, X., Shi, S., Liu, L., Wang, P., Liu, R., & Kong, J. (2016). Transcutaneous vagus nerve stimulation modulates default mode network in major depressive disorder. Biological Psychiatry, 79(4), 266–273. https://doi.org/10.1016/j.biopsych.2015.03.025
Fertonani, A., & Miniussi, C. (2017). Transcranial electrical stimulation: What we know and what we need to know. The Neuroscientist, 23(2), 109–123. https://doi.org/10.1177/1073858416631966
Fregni, F., El-Hagrassy, M. M., Pacheco-Barrios, K., Carvalho, S., Leite, J., Simis, M., Brunelin, J., Nakamura-Palacios, E. M., Marangolo, P., Venkatasubramanian, G., San-Juan, D., Caumo, W., Bikson, M., & Brunoni, A. R. (2021). Evidence-based guidelines and secondary meta-analysis for the use of transcranial direct current stimulation in neurological and psychiatric disorders. International Journal of Neuropsychopharmacology, 24(4), 256–313. https://doi.org/10.1093/ijnp/pyaa051
Frohlich, F. (2015). Experiments and models of cortical oscillations as a target for noninvasive brain stimulation. Progress in Brain Research, 222, 41–73. https://doi.org/10.1016/bs.pbr.2015.07.025
Garcia, R. G., Lin, R. L., Lee, J., Kim, J., Barbieri, R., Sclocco, R., Wasan, A. D., Edwards, R. R., Rosen, B. R., Napadow, V., & Hadjikhani, N. (2017). Modulation of brainstem activity and connectivity by respiratory-gated transcutaneous vagus nerve stimulation in migraine patients. Pain, 158(8), 1461–1472. https://doi.org/10.1097/j.pain.0000000000000930
Hein, E., Nowak, M., Kiess, O., Biermann, T., Bayerlein, K., Kornhuber, J., & Kraus, T. (2013). Auricular transcutaneous electrical nerve stimulation in depressed patients: A randomized controlled pilot study. Journal of Neural Transmission, 120(5), 821–827. https://doi.org/10.1007/s00702-012-0908-6
Herrmann, C. S., Strüber, D., Helfrich, R. F., & Engel, A. K. (2016). EEG oscillations: From correlation to causality by transcranial alternating current stimulation. Frontiers in Human Neuroscience, 10, 378. https://doi.org/10.3389/fnhum.2016.00378
Inukai, Y., Saito, K., Sasaki, R., Tsuiki, S., Miyaguchi, S., Kojima, S., Masaki, M., Otsuru, N., & Onishi, H. (2016). Comparison of the effects of high-frequency and low-frequency transcranial random noise stimulation on motor cortical excitability. Frontiers in Human Neuroscience, 10, 380. https://doi.org/10.3389/fnhum.2016.00380
Kasschau, M., Reisner, J., Sherman, K., Bikson, M., Datta, A., & Charvet, L. E. (2016). Transcranial direct current stimulation at home (tDCS-Home): An open-label feasibility study of remotely supervised and ecologically valid delivery. Neuromodulation: Technology at the Neural Interface, 19(5), 521–533. https://doi.org/10.1111/ner.12428
Kellner, C. H., Greenberg, R. M., Murrough, J. W., Bryson, E. O., Briggs, M. C., & Pasculli, R. M. (2020a). ECT in treatment-resistant depression. The American Journal of Psychiatry, 177(8), 774–775. https://doi.org/10.1176/appi.ajp.2020.19121287
Kellner, C. H., Obbels, J., & Sienaert, P. (2020b). When to consider ECT in treatment-resistant depression. The Journal of Clinical Psychiatry, 81(4), 19ac13146. https://doi.org/10.4088/JCP.19ac13146
Kolshus, E., Jelovac, A., & McLoughlin, D. M. (2017). Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: A systematic review and meta-analysis of randomized controlled trials. Psychological Medicine, 47(3), 518–530. https://doi.org/10.1017/S0033291716002622
Kuo, M. F., & Nitsche, M. A. (2012). Effects of transcranial electrical stimulation on cognition. Clinical EEG and Neuroscience, 43(3), 192–199. https://doi.org/10.1177/1550059412444975
Lefaucheur, J. P., Antal, A., Ayache, S. S., Benninger, D. H., Brunelin, J., Cogiamanian, F., Cotelli, M., De Ridder, D., Ferrucci, R., Langguth, B., Marangolo, P., Mylius, V., Nitsche, M. A., Padberg, F., Palm, U., Poulet, E., Priori, A., Rossi, S., Schecklmann, M., ... Paulus, W. (2017). Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clinical Neurophysiology, 128(1), 56–92. https://doi.org/10.1016/j.clinph.2016.10.087
Lisanby, S. H. (2007). Electroconvulsive therapy for depression. The New England Journal of Medicine, 357(19), 1939–1945. https://doi.org/10.1056/NEJMct075234
Martin, D. M., Liu, R., Alonzo, A., Green, M., & Loo, C. K. (2014). Use of transcranial direct current stimulation (tDCS) to enhance cognitive training: Effect of timing of stimulation on task performance. Experimental Brain Research, 232(10), 3345–3353. https://doi.org/10.1007/s00221-014-4022-x
Miniussi, C., Harris, J. A., & Ruzzoli, M. (2013). Modelling non-invasive brain stimulation in cognitive neuroscience. Neuroscience & Biobehavioral Reviews, 37(8), 1702–1712. https://doi.org/10.1016/j.neubiorev.2013.06.014
Nasr, M., Hashemi, S. S., Mahmoudi, A., & Gharibzadeh, S. (2022). Closed-loop transcranial electrical stimulation: A review of the state-of-the-art. Frontiers in Human Neuroscience, 16, 929007. https://doi.org/10.3389/fnhum.2022.929007
National Institute for Health and Care Excellence. (2022). Evidence standards framework for digital health technologies (NICE Process and Methods Guides PMG39). National Institute for Health and Care Excellence. https://www.nice.org.uk/corporate/pmg39
Nejati, V., Salehinejad, M. A., & Nitsche, M. A. (2018). Interaction of the left dorsolateral prefrontal cortex (l-DLPFC) and right orbitofrontal cortex (r-OFC) in hot and cold executive functions: Evidence from transcranial direct current stimulation (tDCS). Neuroscience, 369, 109–123. https://doi.org/10.1016/j.neuroscience.2017.10.042
Nitsche, M. A., & Paulus, W. (2000). Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. The Journal of Physiology, 527(3), 633–639. https://doi.org/10.1111/j.1469-7793.2000.t01-1-00633.x
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Palm, U., Kumpf, U., Behler, N., Wulf, L., Kirsch, B., Wörsching, J., Fallgatter, A., Padberg, F., & Brunoni, A. R. (2018). Home use, remotely supervised, and clinic-based transcranial direct current stimulation (tDCS) for the treatment of major depressive disorder: A systematic review and meta-analysis. Brain Stimulation, 11(6), 1219–1235. https://doi.org/10.1016/j.brs.2018.08.006
Polanía, R., Nitsche, M. A., & Ruff, C. C. (2018). Studying and modifying brain function with non-invasive brain stimulation. Nature Neuroscience, 21(2), 174–187. https://doi.org/10.1038/s41593-017-0054-4
Prudic, J. (2019). Strategies for minimizing cognitive side effects of electroconvulsive therapy. In S. M. McClintock & M. V. Husain (Eds.), Neurocognition and brain stimulation in psychiatric disorders (pp. 45–68). Oxford University Press.
Rabany, L., Weisinger, B., George, M. S., & Harel, E. V. (2022). Transcranial electrical stimulation combined with cognitive behavioral therapy for depression: Systematic review and future guidelines. Journal of Psychiatric Research, 148, 203–212. https://doi.org/10.1016/j.jpsychires.2022.01.062
Razza, L. B., Palumbo, P., Moffa, A. H., Carvalho, A. F., Zheng, X., Bikson, M., Loo, C., & Brunoni, A. R. (2020). A systematic review and meta-analysis on the effects of transcranial direct current stimulation in depressive episodes. Depression and Anxiety, 37(7), 594–608. https://doi.org/10.1002/da.23004
Rong, P., Liu, A., Zhang, J., Wang, Y., Yang, A., Li, L., Ben, H., Li, X., Liu, J., Liu, R., Wang, F., & Fang, J. (2016). An alternative therapy for major depressive disorder: Transcutaneous auricular vagus nerve stimulation. European Journal of Integrative Medicine, 8(1), 3–10. https://doi.org/10.1016/j.eujim.2016.02.001
Sackeim, H. A., Dillingham, K. E., Prudic, J., Cooper, T., McCall, W. V., Peterchev, A. V., Youssef, N. A., Isenberg, K. E., Lisanby, S. H., & Morales, O. (2020). Effect of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimulation, 13(5), 1404–1413. https://doi.org/10.1016/j.brs.2020.07.014
Saturnino, G. B., Antunes, A., & Thielscher, A. (2015). On the importance of electrode parameters for electric field computations in transcranial electrical stimulation. NeuroImage, 120, 82–93. https://doi.org/10.1016/j.neuroimage.2015.06.067
Sclocco, R., Garcia, R. G., Kettner, N. W., Isenburg, K., Fisher, H. P., Huff, T. F., Wightman, S. D., Goldstein, J., Makris, N., Toschi, N., Barbieri, R., & Napadow, V. (2019). The vagal sensory pathway: Investigating its anatomical and functional connectivity in human brainstem using high-resolution fMRI. Brain Stimulation, 12(4), 882–892. https://doi.org/10.1016/j.brs.2019.03.003
Semkovska, M., & McLoughlin, D. M. (2010). Objective cognitive performance associated with electroconvulsive therapy for depression: A systematic review and meta-analysis. Biological Psychiatry, 68(6), 568–577. https://doi.org/10.1016/j.biopsych.2010.06.009
Thielscher, A., Antunes, A., & Saturnino, G. B. (2015). Field modeling for transcranial magnetic stimulation: A useful tool to understand the physiological effects of TMS? Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), 2015, 222–225. https://doi.org/10.1109/EMBC.2015.7318340
Tor, P. C., Bautovich, A., Wang, M. J., Martin, D., Harvey, S. B., & Loo, C. (2015). A systematic review and meta-analysis of brief versus ultrabrief pulse electroconvulsive therapy for depression. The Journal of Clinical Psychiatry, 76(9), e1092–e1098. https://doi.org/10.4088/JCP.14r09145
Tracey, K. J. (2009). Reflex principles of immunological homeostasis. Annual Review of Immunology, 27, 493–519. https://doi.org/10.1146/annurev.immunol.021208.131710
Truong, D. Q., Magerowski, G., Pascual-Leone, A., Alonso-Alonso, M., & Bikson, M. (2013). Finite element method simulation of transcranial direct current stimulation in realistic human head models: Analysis of target controllability. Journal of Neural Engineering, 10(6), 066004. https://doi.org/10.1088/1741-2560/10/6/066004
Valle, R. (2020). The role of electroconvulsive therapy in the treatment of major depressive disorder: Indications, efficacy, and cognitive safety. Psychiatry and Clinical Neurosciences, 74(7), 380–388. https://doi.org/10.1111/pcn.13018
Wang, L., Zhang, J., Guo, C., He, J., Zhang, S., Wang, Y., Guo, X., Rong, P., & Fang, J. (2022). The neural mechanism of transcutaneous auricular vagus nerve stimulation on major depressive disorder: A resting-state fMRI study. Journal of Affective Disorders, 308, 388–397. https://doi.org/10.1016/j.jad.2022.04.092
Woodham, R. D., Rimmer, R. M., Young, A. H., & Fu, C. H. (2022). At-home transcranial direct current stimulation (tDCS) for major depressive disorder: A systematic review and meta-analysis of randomized controlled trials. Journal of Affective Disorders, 308, 303–311. https://doi.org/10.1016/j.jad.2022.04.048
World Health Organization. (2023). Global strategy on digital health 2020–2025. World Health Organization. https://iris.who.int/handle/10665/344249
Wurzman, R., Yaden, D., & Giordano, J. (2016). Out-of-the-lab and into the wild: Ethical, legal, and social issues of direct-to-consumer transcranial electrical stimulation (tES) devices. Human Nature and Brain Dynamics, 10(1), 12–28. https://doi.org/10.3389/fnsys.2016.00058
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Radosław Swędrak, Zuzanna Dobrakowska, Jakub Klepacz
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
