LAUSR

COVID-19 is a global pandemic that is expected to infect millions and kill up to hundreds of thousands of people, with a troubling rise in cases each day [1]. It is first and foremost a deadly virus. However, what many have not yet considered are the secondary mental health effects that will likely occur the ongoing efforts to reduce the impact of COVID-19. Here we discuss how at-home neurotherapeutics, including telehealth and self-administered brain stimulation, could help to curtail some of the possible mental health ripple effects caused by COVID-19. Currently, billions of people worldwide have been told to selfisolate to limit the spread of COVID-19. To be clear, this selfisolation strategy is the correct and necessary one and is supported by modeling that highlights how reducing human-to-human contact could help to lessen the impact of the disease [2]. However, the call for self-isolation has resulted in the reduction of inperson social interactions on a magnitude that the world has not experienced since the Spanish Flu pandemic of 1918e1919. This social isolationwill likely lead to an increase in depression, a link that has been established with previous studies in humans [3] and nonhuman mammals such as prairie voles [4]. Social isolation secondarily limits access to mental health resources, preventing many who need psychological help from getting it. Put together, there is an urgent demand for more accessible mental health services during this COVID-19 self-isolation period. The need for at-home neurotherapeutics is now. The current toolbox for at-home mental health treatments is largely limited to telehealth, where providers remotely communicate with patients over the phone or using video. There is a need for the rapid production and dissemination of other tools such as selfadministered, at-home brain stimulation, which could help to curtail the mental health effects from self-isolation. One option could be to adopt existing clinical brain stimulation technologies that are used for depression to at-home settings. For instance, high frequency (>5Hz) repetitive transcranial magnetic stimulation (rTMS) is a United States Food and Drug Administration (FDA) approved for treatment resistant depression (TRD). Treatments typically require a TMS operator to hold a TMS coil over the left dorsolateral prefrontal cortex (DLPFC) to noninvasively pass electromagnetic pulses into this brain region that is underactivated in depression. A recent variant of this treatment for depression is using 360 pulses of daily low frequency (1Hz) rTMS to the right DLPFC, with the specific intention of evaluating this treatment paradigm for at-home administration [5]. Preliminary results using this approach have been promising, with 37.2% of