Cranial Electrotherapy Stimulation: Science and Evidence

Introduction:

Cranial Electrotherapy Stimulation (CES) is a non-drug treatment used primarily for anxiety, depression, and insomnia. It can be used as a single modality, or in combination with psychotropic medications, psychotherpy, biofeedback, and other therapies. It essentially consists of applying a very low current that is usually pulsed at 0.5 to 500 Hz to the temples, mastoid processes, or the earlobes. It is not clear at this time if any of the CES devices have a superior waveform however. There are a few devices on the market which the FDA allows to promote for the treatment of anxiety, depression, and insomnia. These devices have also been used "off label" for pain and addictive disorders. CES devices require a prescription in the United States and should only be used under the care of a licensed professional. Generally the devices must be used about 20 to 40 minutes per day, at least a few times per week, for about a month to really appreciate efficacy. Some individuals sense an immediate benefit however, especially when used for anxiety disorders, where the user might feel relaxed but also alert entering into an "alpha state" as demonstrated by the presence of alpha waves on an EEG. CES has been around for many years. The research I have seen conce
ing its efficacy is relatively good, and my clinical experience has also been good. It seems to be relatively safe, however CES may be contraindicated if you have a pacemaker, are pregnant, nursing, or have a seizure disorder. It may also cause some dizziness and nausea among other side effects but is generally well tolerated.

Science:

CES is actually one of many brain electo-stimulation treatments in psychiatry which also include electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS), and deep brain stimulation (DBS). Like all of these modalities, the exact mechanism of CES is uncertain, however it is postulated to modulate the neurotransmitter systems inducing neurons to produce serotonin, dopamine, neurohormones e.g. DHEA, and endorphins. Specifically, CES is thought to primarily act on the brain's hypothalamic region, bringing the brain back to pre-pathological homeostasis. By comparison to the other modalities, CES is relatively noninvasive, safe, and inexpensive. All of the treatments, like CES may take from days to weeks to achieve their maximum therapeutic benefit and may be used in combination with psychotropic medications and other treatments. Unlike the other electro-stimulation modalities, CES may be used as a first line treatment, while the others are typically reserved for refractory and severe cases.

Evidence:

While Cranial Electrotherapy Stimulation has been in use for decades, it is currently gaining in popularity, perhaps due to advances in electro-stimulation treatments in general. It was first researched in the Soviet Union in the 1950s, though the idea of using low current stimulation to the brain to induce sleep dates back to 1902. There are a multitude of studies supporting the use of CES for anxiety, depression, insomnia, addictive and pain disorders. The FDA specifically approves the use of CES for anxiety, depression, and insomnia, as several devices were "grandfathered in." The FDA "grandfathered" these devices based on their demonstrated efficacy, though, they never had to go through the rigorous requirements that the FDA has required for new technologies, or medications that are currently subject to review. Nevertheless, there are well over a hundred studies which support this technology, primarily for anxiety, depression, and insomnia. Many of the studies have been sponsored in some way by the wholesalers or manufacturers of the devices as their devices were needed for the research. These companies in my opinion have done a very good and objective job publishing these studies along with other studies on their respective websites, and I recommend the interested reader to refer to their websites at alph-stim.com for Electromedical Products International, fisherwallace.com for Fisher Wallace, and cesultra.com for Neuro Fitness LLC.. Additional information on CES and CES devices may be found on my website www.cranial-electrotherapy.com. I also strongly encourage individuals to perform their own literature searches which may easily be accomplished on the internet for CES

As a final note on this topic, the companies above all offer trial periods of 30 to 60 days with their products with limited if any fees if the devices are returned. Thus even the most cynical skeptic, might see for themself, if CES actually works!