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The Therapeutic Potential of Cranial Electrotherapy Stimulation for Mental Health Disorders and Behavioral Dysregulation
Cranial Electrotherapy Stimulation (CES) has shown significant efficacy in reducing anxiety, depression, and insomnia and offers a promising alternative to pharmacological treatments. Recent studies highlight its potential for behavioral regulation in individuals with neurodevelopmental disorders, demonstrating its broad therapeutic applications.
Originally developed for sleep in Russia in the 1960s, Cranial Electrotherapy Stimulation (CES) has become a mainstay of my practice for over 20 years. I use it with children and adults for sleep anxiety and maintaining sobriety. It’s easy to use and non-invasive, and in my experience, it either works for you or doesn't, which may account for the divergent research about it. There are many vendors out there, but Alpha-Stim is among the oldest and best. A licensed clinician needs to write a prescription for it. I have my favorite (means “efficient”) distributor, so if you want a personal introduction, drop me a note.
Tags: cranial electrotherapy stimulation, anxiety, depression, insomnia, behavioral dysregulation
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- Course(s): Mental Health Disorders
- Book(s): Rhythms of Recovery
Research Glossary
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Referenced Research Publications
Frontiers in psychiatry
2023, April 06
DOI: https://doi.org/10.3389/fpsyt.2023.1157473
Efficacy of electrical cranial stimulation for treatment of psychiatric symptoms in patients with anxiety: A systematic review and meta-analysis
Abstract
Background: Therapeutic effects of electrical cranial stimulation (CES) in patients suffering from anxiety remained unclear. This meta-analysis aimed at investigating acceptability and therapeutic efficacy of CES against anxiety, depression, and insomnia for patients who experienced symptoms of anxiety.
Methods: Major electronic databases were searched from inception until December 10, 2022 for randomized controlled trials (RCT) focusing on therapeutic effectiveness of CES in patients whose primary complaints included anxiety. Effect sizes (ES) for different treatment outcomes were estimated by using generic inverse variance method.
Results: Eight RCTs were identified including a total of 337 participants. The therapeutic effectiveness of CES was significantly better than that in the control groups for anxiety (ES=-0.96, p <0.00001, eight trials, 337 patients), depression (ES=-0.69, p=0.003, five trials), and insomnia (ES=-1.02, p = 0.0006, three trials) in those who presented with symptoms of anxiety. Subgroup analyses found that CES was equally effective regardless of comorbid presentation of depressive symptoms (ES=-0.94 in patients with anxiety only vs. ES=-1.06 in those with depression and anxiety) and whether CES was used as monotherapy or add-on therapy to medications (ES = −0.88 vs. ES = −1.12, respectively). Moreover, subgroup analysis of RCTs using the same device “Alpha-Stim” for CES was more effective in alleviating anxiety than sham controls (ES = −0.88, p < 0.00001, four trials, 230 patients). Regarding acceptability, the use of CES did not increase the risk of treatment-related dropout compared to the control group (RR = 1.26, p = 0.57, I2 = 0%, four trials, 324 patients).
Conclusion: Our study supported the use of CES for symptoms of anxiety, depression, and insomnia in those suffering from anxiety with fair acceptability and demonstrated the efficacy of “Alpha-Stim”, the most commonly used device for CES, in this patient population.
Reference
Chung, F. C., Sun, C. K., Chen, Y., Cheng, Y. S., Chung, W., Tzang, R. F., Chiu, H. J., Wang, M. Y., Cheng, Y. C., & Hung, K. C. (2023). Efficacy of electrical cranial stimulation for treatment of psychiatric symptoms in patients with anxiety: A systematic review and meta-analysis. Frontiers in psychiatry, 14, 1157473. https://doi.org/10.3389/fpsyt.2023.1157473
Brain stimulation
2023, January 04
DOI: https://doi.org/10.1016/j.brs.2023.01.823
The effect of cranial electrotherapy stimulation as adjunctive therapy on generalized anxiety disorder in elderly: an open-label, pilot study
Abstract
Cranial electrotherapy stimulation (CES) is a noninvasive brain stimulation that has been used for the treatment of anxiety, depression, and insomnia. There was no study examining the role of CES in treating generalized anxiety disorder (GAD) in the elderly. We conducted a single-arm open-label trial. Twenty-seven patients from 60 to 78 years of age with GAD were enrolled from February 2021 to November 2022. CES treatment was administered for 6 weeks using the Alpha-Stim stimulator at 0.5-Hz frequency and 50 to 500 uA. Patients received 60 minutes daily stimulation for six weeks and follow-up for one month. The primary efficacy measures were the change over time in the Hamilton Rating Scale for Anxiety (HAM-A), which was measured at baseline, 4- and 6-week, and at one-month follow-up. Response and remission were defined as a reduction of 50% or more and equal or less than 7 on the scales, respectively (Trial Registration: clinicaltrials.gov Identifier: NCT04465136). Among 27 patients, 24 (88.9%) completed the trial. Intention-to-treat (ITT) analysis showed a significantly decrease in HAMA scores from baseline (20.96 ± 3.30) to 6-week (12.26 ± 7.09) stimulation endpoint (t = -7.138, p < 0.001) and one-month (12.85 ± 7.08 follow-up period (t = -6.166, p < 0.001). At 6-week and one-month follow-up visit, 11 patients (40.7% of the ITT sample and 41.7% of completers) and 13 patients (48.1% of the ITT sample and 50.0% of completers) met criteria for responders. Additionally, 8 patients (29.6% of the ITT sample and 29.2% of completers) and 7 patients (29.6% of the ITT sample and 29.2% of completers) met criteria for remitter at 6-week and one-month follow-up visit. Adverse events were generally mild and self-limited. This preliminary study suggests that CES may reduce symptoms of anxiety in the elderly. The findings should be confirmed in a double-blinded sham-controlled trial.
Reference
Chu, C. S. (2023). The effect of cranial electrotherapy stimulation as adjunctive therapy on generalized anxiety disorder in elderly: an open-label, pilot study. Brain Stimulation, 16(1), 404. https://doi.org/10.1016/j.brs.2023.01.823
Medicine
2022, September 02
DOI: https://doi.org/10.1097%2FMD.0000000000030336
Comparison of the effects of cranial electrotherapy stimulation and midazolam as preoperative treatment in geriatric patients: A CONSORT-compliant randomized controlled trial
Abstract
Background: Although midazolam is widely administered as an anxiolytic premedication, it may cause over-sedation and hypoxia in geriatric patients. Cranial electrotherapy stimulation (CES) is a nonpharmacological device with anxiolytic effect. This study compared the effects of CES and midazolam as a preoperative treatment in geriatric patients.
Methods: Eighty patients, under the age of 65 to 79 years, undergoing general anesthesia were randomly assigned into midazolam premedication group (M group, n = 40) or CES pretreatment group (CES group, n = 40). The patients in the M group were intramuscularly injected with midazolam (0.07 mg/kg) 30 minutes before receiving general anesthesia. The patients in the CES group received 20 minutes of CES pretreatment on the day before and on the morning of the surgery.
Results: In the preoperative holding area, the anxiety score (P = .02) and the sedation score (P < .001) were significantly lower in the CES group compared with those in the M group. The oxygen saturations at the preoperative holding area and the operating room were significantly higher in the CES group than those in the M group (P < .001).
Conclusions: CES pretreatment relieved preoperative anxiety with less risk of over-sedation and respiratory depression than midazolam premedication in geriatric patients.
Reference
Park, B. S., Jin, S., Kim, W. Y., Kang, D. S., Choi, Y. J., & Lee, Y. S. (2022). Comparison of the effects of cranial electrotherapy stimulation and midazolam as preoperative treatment in geriatric patients: A CONSORT-compliant randomized controlled trial. Medicine, 101(35), e30336. https://doi.org/10.1097/MD.0000000000030336
Journal of Integrative Neuroscience
2023, August 14
DOI: https://doi.org/10.31083/j.jin2205119
An Open-Label Study of Cranial Electrotherapy Stimulation on Behavioral Regulation in a Mixed Neurodevelopmental Clinical Cohort
Abstract
Objective: Individuals with neurodevelopmental disorders often report disturbances in the autonomic nervous system (ANS)-related behavioral regulation, such as sensory sensitivity, anxiety, and emotion dysregulation. Cranial electrotherapy stimulation (CES) is a method of non-invasive neuromodulation presumed to modify behavioral regulation abilities via ANS modulation. Here we examined the feasibility and preliminary effects of a 4-week CES intervention on behavioral regulation in a mixed neurodevelopmental cohort of children, adolescents, and young adults.
Methods: In this single-arm open-label study, 263 individuals aged 4–24 who were receiving clinical care were recruited. Participants received at-home CES treatment using an Alpha-Stim® AID CES device for 20 minutes per day, 5–7 days per week, for four weeks. Before and after the intervention, a parent-report assessment of sensory sensitivities, emotion dysregulation, and anxiety was administered. Adherence, side effects, and tolerance of the CES device were also evaluated at follow-up.
Results: Results showed a 75% completion rate, an average tolerance score of 68.2 (out of 100), and an average perceived satisfaction score of 58.8 (out of 100). Additionally, a comparison between pre- and post-CES treatment effects showed a significant reduction in sensory sensitivity, anxiety, and emotion dysregulation in participants following CES treatment.
Conclusions: Results provide justification for future randomized control trials using CES in children and adolescents with behavioral dysregulation.
Significance: CES may be a useful therapeutic tool for alleviating behavioral dysregulation symptoms in children and adolescents with neurodevelopmental differences.
Reference
Brandes-Aitken, A., Gerdes, M., Hattangadi, N., Shapiro, K. A., & Marco, E. J. (2023). An open-label study of cranial electrotherapy stimulation on behavioral regulation in a mixed neurodevelopmental clinical cohort. Journal of Integrative Neuroscience, 22(5), 119. https://doi.org/10.31083/j.jin2205119