Depression Treatment with Cranial Electrotherapy Stimulation (CES)


CES involves small, hardly noticeable, electric current pulsed across the patient's head in a device that can be used at home.

History

It is a common knowledge that the electro-medicine has been in existence for over a thousand years—in 46 AD, Roman physician Scribonius Largus recommended his patients stand on a live torpedo fish for the relief of a variety of medical conditions, including insomnia and headaches. Roman Emperor Claudius Galen (131 - 201 AD) attached electric eels to his head to subdue headaches. However, new technological achievements and scientific development allows to significantly advance the related treatment approaches.

Modern Cranio-Electro Stimulation (CES) started in Russia around the 1940s as a treatment for insomnia and heaps of research over the past 25 years has shown that CES not only helps with insomnia but it diminishes anxiety and enhances cognition and memory capacity and may even help recovering alcoholics and drug addicts.

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The treatment of anxiety and depression with CES began in the United States in the early 1960s and it is currently routinely prescribed by thousands physicians and mental health practitioners in the US and Canada for a variety of brain-related psychiatric conditions, although it has yet to achieve full acceptance as a mainstream medical treatment. This is probably because sufficient information has not been made available to the majority of medical practitioners regarding the safety and efficacy of CES and the pharmaceutical industry spends a great deal of money every year promoting the use of medications instead of such alternative therapies as CES.

While there are over 150 published scientific research studies on the use of CES. The overwhelming majority of these studies support the safety and efficacy of CES in the treatment of a number of psychological disorders; particularly anxiety, depression and insomnia. Yet the majority of Canadian physicians in general medical practice are simply unaware of them. Unlike pharmaceuticals, there is no large industry promoting CES to physicians.

While CES is FDA-approved solely for the treatment of anxiety, depression and insomnia, there is scientific data showing promise in the treatment of other conditions such as pain, tension/migraine headaches, fibromyalgia, and substance dependencies (i.e., may reduce symptoms associated with alcohol, drug or tobacco withdrawal), as well as for calming agitated and aggressive patients with neuropsychiatric conditions.

For those who are conjuring up images scary doctors and straightjackets, don’t worry. This has nothing to do Electroconvulsive therapy (ECT)—electroshock therapy, where medical professionals administer an electric shock to the brain like something in a 50’s shock film. Cranial electrotherapy stimulation is a very gentle treatment, with a minor pleasant buzz-like feeling, which you control, and which you can do yourself.

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Mechanism of action

The exact mechanism of action of CES remains unclear but experts suggest that CES reduces the emotional stress, which is considered as being a main cause and substantial trigger for numerous emotional disorders. The proposed mechanism of action for CES is that the pulses of electric current increase the ability of neural cells to produce serotonin, dopamine DHEA endorphins and other neurotransmitters stabilizing the neuro-hormonal system.

It has been proposed that during CES, an electric current is focused upon the hypothalamic region; during this process, CES electrodes are placed on the ear at the mastoid, near to the face. Computer modeling suggests that current of similar magnitudes maybe induced in both cortical and sub-cortical regions. The prediction that CES induced current intensities in the sub-cortical structures are not sufficiently decreased from the cortical structures is potentially clinically meaningful.

It has been suggested that the current results in an increase of the brain's levels of serotonin, norepinephrine, and dopamine, and a decrease in its level of cortisol. After a CES treatment, users are in an "alert, yet relaxed" state, characterized by increased alpha and decreased delta brain waves as seen on EEG.

Soroush Zaghi et al. published an article in the journal The Neuroscientist, finding that CES increases the production of serotonin, GABA, and endorphins. These neurochemical changes theoretically explain any practical positive effects that are experienced from CES.

Note that most cranial electrotherapy stimulators are limited to 600 µA. To put this into perspective, it takes one-half of an ampere to light an ordinary 60 watt light bulb. To truly compare the work done per second by these two different currents, we must multiply the currents by the respective voltages that drive them. The product of current x voltage is a measure of the rate of generation of energy, and is referred to as the power output. By definition, when a device outputs one ampere of current with a one volt driving force, the power output of the device is one watt. Therefore a device producing a maximum output of 600 µA is limited to about 11,000 times less power than the light bulb: (600/1,000,000) amperes x 9 volts = 0.0054 watts. Some people do not even feel this amount of current.

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What does CES feel like?

Applied to the ear lobes or to the mastoid, just behind the ear, CES causes the patient to experience nothing more than a faint tingling sensation. As the treatment continues, most patients begin to feel less anxious, less distressed, and more relaxed and, yet, mentally alert and focused. Patients with positive response to CES generally sleep better and report improved concentration, increased learning abilities, enhanced recall and a heightened state of well-being after one or a series of CES treatments. Most people can resume normal activities immediately after treatment. Some people may experience a euphoric feeling, or a state of deep relaxation that may temporarily and minimally impair their mental and/or physical abilities for the performance of potentially hazardous tasks, such as motor vehicle operation. In some cases, this may last for up to several hours after treatment. Users may do other things during treatment such as read, watch TV, engage in conversation, or work on a computer.

CAUTIONARY NOTE: Until you have experienced CES for yourself and are certain of how you will react to treatment, it is best that you do operate a motor vehicle or other motorized equipment or engage in potentially hazardous activities immediately after treatment.

Most patients are left feeling relaxed and alert after a CES session— in what psychologists call an “alpha state”. This state differs from pharmaceutical treatments in that people report feeling that their bodies are lighter and more relaxed and their minds more alert and clear. The results tend to be cumulative and lasting.

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Regulation

In the United States, CES technology is classified by the Food and Drug Administration as Class III medical devices and must be dispensed by or on the order of licensed healthcare practitioners, i.e. a physician, psychiatrist or nurse practitioner; psychologists, physician assistants, and occupational therapists who have an appropriate electrotherapy license may prescribe CES, dependent upon state regulations.

As a result of the 1976 Medical Device Amendments, manufacturers who prove both safety and efficacy may enter the market, with FDA clearance, utilizing the 510(k) process instead of the premarket approval process, at this time. There are currently three major manufacturers of cranial electrotherapy stimulation (CES) in the United States and one in Canada.

The Neurological Devices Panel rejected 2012 a call from the CES manufacturers to setup less restrictive category for CES.

Advocates for the less restrictive Class II category, which requires general or special postmarket controls without PMA, include Jerrold Rosenbaum, MD, Chief of Psychiatry at Massachusetts General Hospital in Boston. “I support CES receiving Class II status in light of its safety in fairly extensive use and positive results observed by many who use it,” Rosenbaum related in a correspondence included in one manufacturer’s petition. “This appears to be a very low risk device without serious side effects.”

Correspondence supporting the lower-risk classification was also received from the Department of the Army. Colonel Dallas Hack, MD, Director of the US Army Combat Casualty Care Research Program, indicated, “CES devices have been prescribed for the treatment of soldiers and veterans with neuropsychiatric conditions who do not respond to psychotropic medications or do not comply with prescriptions.”

Although common adverse effects of the devices, such as skin irritation, headaches, and dizziness, were generally found to be tolerable and were characterized by the advisory panel as “appropriate risks,” the Agency report also noted the potential risk of seizure “or other adverse effects from electrical stimulation of the brain.”

The principle safety concern, however, is the worsening of the condition being treated if the device is not effective. “A key concern stemming from our review of the literature,” the FDA reported, “is that use of CES in lieu of more effective, proven therapies may present undue risk to patients whose psychiatric conditions may worsen if untreated.”

In any case, you can legally apply the CES on yourself at home, but the procedure should be prescribed by the certified professional, and it should be accompanied with the documented treatment plan.

Equipment

The CES-Ultra is a small device that you can use yourself to treat depression, anxiety and insomnia. It looks a bit like an iPod, so you can take it anywhere and use it whenever you. It sends microcurrents (similar to levels within the brain) through the brain at a variety of frequencies. This patented waveform normalizes the electrical activity of the nervous system producing a calming yet focused effect. Effects can be seen after a single treatment, and repeated treatments increase the strength and period of these effects. CES-Ultra technology can be beneficial to patients with pain, anxiety, depression and sleep disorders.

The microcurrent produced by the Fisher Wallace stimulator provokes a natural extension of your brain’s electricity, affecting your brainwaves and providing a slight energy boost to your central nervous system. Therefore it increases the feel-good factor, and inhibits feelings of depression and anxiety. The Fisher Wallace stimulator is available to the public for home use (by prescription only), and the results of research into its efficacy and safety is easily obtainable. The many benefits of CES devises tend to be cumulative in nature and gradually reveal themselves over a period of 1 to 3 weeks. Research demonstrates that CES produces a mild stimulation in the hypothalamic area of the brain, resulting in balancing neurotransmitter activity (in particular Beta Endorphin and Norepinephrine). The effects achieved are similar to that of a "runner's high."

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