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Cranial Electrotherapy Stimulation: A Non-Drug Neuromedical Treatment
Cranial electrotherapy stimulation (CES), (also known as “electrosleep”, “transcranial electrotherapy” and by many other names), involves a form of treatment that sends low intensity microcurrent (under 1 milliampere) to the brain. [1] CES devices function differently from other biomedical electronics, such as deep brain stimulating electrodes (which prevent seizures and hand tremors) [2] and heart pacemakers. While those instruments require surgical implantation, CES operates non-invasively. Designed for home use, the devices deliver current to the brain via a hand held machine to electrodes attached on or behind the ears. [3]
Uses for Brain Health
A wide body of research suggests that the technique effectively treats insomnia, depression and anxiety (the only FDA approved uses). Scientific data also shows promise for other conditions such as pain, tension/migraine headaches, fibromyalgia, and ADHD. CES might also provide benefits for chemical dependencies (such as street and prescription drugs, alcohol, and tobacco); that is, it might help the insomnia, anxiety and depression that often manifest during withdrawal. [4,5]
Patient Experience
The devices, sold by prescription in the U.S., require initial assessment and ongoing medical follow-up. [6] Treatment protocols vary based upon the health issue and the phase of treatment. Therefore, patients with anxiety typically use devices for 20-60 minutes daily for the first 2 to 3 weeks, with less frequent use thereafter. [7] Users may do other things during treatment (such as read, watch TV), but should not drive or operate machinery during or shortly after treatment. [8]
Individual responses may vary, but most users report reduced symptoms (such as anxiety) after their first or second treatment. Severe depression however, may require three weeks for therapeutic results. During use, patients often experience pleasant mental states with increased muscle relaxation yet enhanced mental clarity. They might also feel a pulsing or tingling, sensation in their earlobes, (considered normal), which setting adjustments can alleviate. Positive effects after a single treatment may last up to two days and effects usually become cumulative. [9]
Brain Effects
Researchers don’t fully understand mechanisms involved, but theorize that CES electrical current helps reestablish optimal brain chemistry and improves efficiency of neural connections. [10] One example of research supporting this theory involves electrical engineering simulations conducted by researchers at the University of Texas, Austin. Their brain mapping techniques suggested that minute amounts of current traveled to the brain’s thalamus, enough to enable release of neurotransmitters. [11] Other research conducted by North Dakota State University utilized EEG techniques to quantify changes during administration of CES versus sham treatment. The research showed frequency distribution shifts suggestive of beneficial changes. [12]
Based on current and ongoing research, neuroscientist Dr. James Giordano postulates that CES microcurrent travels to the base of the brain (the brainstem), activating clusters of nerve cells which make the brain chemicals serotonin and acetylcholine. Serotonin is linked to relaxation [13] while acetylcholine is linked to body processes not under conscious control while at rest. [14] Released by nerve cells at the synapse, these neurotransmitters influence pathways within the brain and spinal cord that inhibit arousal and agitation. The resulting “fine tuning” helps the nervous system to restore homeostatic balance and possibly creates brain patterns known as alpha rhythms. Measurable via brain wave recordings (called EEG); scientists often associate alpha states with enhanced mental focus and relaxation. Neurological processes linked to alpha states seem to reduce stress, stabilize mood, and exert control over certain types of pain.
Effectiveness
Scientists conducted much of the early work on CES in France. Starting work in the early 1900′s, they theorized that minute amounts of current (applied to the head) would calm the central nervous system, inducing a sleep-like state. [16] The technique took hold in the West in the late 1960′s, when Austria hosted International Symposia on the topic. The uneven quality of studies published up until that time however, generated skepticism as well as further research. Still in progress, the scientific community has accumulated years of research, which spans the past century. [17]
In his recently revised book, The Science Behind Cranial Electrotherapy Stimulation, Daniel L. Kirsch reviewed CES research from the last 40 years which includes 126 human and 29 animal studies, and 31 review articles. Over half came from peer-reviewed sources and most, coming from major US universities used double blind techniques. Of studies reviewed, 112 (89%), claimed positive results. Seventeen follow-up studies evaluating residual effects (lasting 1 week to 2 years) showed at least some continuing effect in all of the patients. [18]
While a body of published research does exist, some have reservations. Research design and quality varies widely and very few peer reviewed journals are publishing recent studies. Complicating matters, makers of the device often lack proper funding to support high quality research. [19] Others think the technique needs more study in terms of practicality and cost effectiveness. [20]
As a way to clarify CES efficacy, medical researchers from the Harvard School of Public Health published a thorough scientific review of CES devices. Their report identified 18 of the most rigorous studies of CES versus sham treatment. They then applied meta-analysis to 14 of those studies, using combined results to further discern effects after treating four different conditions. [21] Reconfirming previous meta-analysis by University of Tulsa researchers, [22] pooling techniques showed CES to be significantly more effective for treating anxiety; but they did not affect results for insomnia, headache, and brain dysfunction. The review team made comment that most studies under scrutiny needed to publish more complete data and blind treatment providers from knowing which patients were getting CES. [23]
Safety/Precautions
CES has an excellent safety record, few side-effects, and works well for all age groups. CES users sometimes have temporary headaches, lightheadedness, skin irritation from electrodes and rare paradoxical reactions (such as excitement, anxiety, sleep problems, or increases in pre-existing depression). Pregnant or lactating women, people with implanted bioelectrical devices, or those taking supplements or medications affecting the brain or vascular system should first consult with a physician. [24] Of 17 follow-up studies conducted up to two years after treatment, none showed negative effects. [25] Very few major short or long-term problems have therefore been found, and several of the devices carry FDA approval. [26]
Implications for Use
CES has been around for many years, yet its use in the U.S. remains little known. First of all, new therapies must prove efficacy to gain recognition. [27] Additionally, medical school training is non-existent, postgraduate continuing education offerings are scarce, and device makers lack marketing resources. [28] Given that mainstream providers and the public seem mostly unaware of the treatment, alternative providers may be prescribing it most. Among the few who do know about CES, opinions vary.
According to Dr. Daniel Kirsch, an authority on electromedicine and Chairman of Electromedical Products International, research shows CES to be safe, having good results for a range of brain based disorders. He believes the evidence supports use as a first line treatment for issues it effectively treats. [29]
Upon their review, insurer Aetna however, found that CES remains “experimental and investigational” for major depression, other psychiatric disorders, and for “neuropsychological indications (alcoholism, chemical dependency, dementia, depression, headache)…” They say that the evidence is encouraging, yet the issue needs more study. [30]
According to distributor Elixa Peak Performance, CES works best as a treatment (not a cure) for the anxiety, insomnia and depression that comes as a byproduct of stress. But the web site also suggests that it can treat a number of other stress related disorders as well as boost IQ and peak performance. [31]
In contrast, physician Dr. Stephen Barret of Quackwatch takes issue with those who claim benefits beyond approved uses or distributors who sell devices with commercial nutritional programs. He does concede that CES has shown effectiveness for anxiety and possible other uses. But he then points out that physicians, naturopaths or chiropractors (who prescribe CES most) might not be qualified to diagnose and treat neuropsychological problems. He further states that it’s better to get to the root of a problem than only treat symptoms. [32]
Writing on behalf of the Houston VA Pain Management Program, psychologists Dr. Gabriel Tan and Dr. Julie Alvarez argue for integrating CES and self hypnosis into multidisciplinary pain treatment programs. Clinic patients usually have intense chronic pain, not helped by analgesics; additionally, they often travel long distances for treatment, having limited means, and social problems. Seeing pain mainly as a physical problem and lacking resources for long treatments, patients often want tangible, fast results. CES and self hypnosis combined therefore meet the need, as they take little time and provide quick results. After getting some measure of relief, patients are often more willing to accept additional psychological help as a part of their treatment plan. [33]
Physician advocates Dr. Marshall F. Gilula and Dr. Paul Barach (in an editorial published by Southern Medical Journal) assert that the device can be a valuable treatment for the approved uses of anxiety, depression, and insomnia. While physicians usually treat those problems with psychoactive drugs, they point out that the medications often pose safety concerns; that is, they have potential for side-effects or dependency. [34] (FDA warnings for selective serotonin reuptake inhibitors used for depression, serve as a prime example.) [35] Like psychoactive drugs, CES does require ongoing medical supervision, but it doesn’t have the same potential for problems. Ultimately, they maintain that CES is of great value as a safe, non-drug alternative which can reduce or sometimes even replace medication use. They say that while CES is not a miracle cure, it is at least worthy of consideration. [36]
References
1. Kirsch DL, Smith RB. Cranial electrotherapy stimulation for anxiety, depression, insomnia, cognitive dysfunction, and pain: a review and meta-analysis. In: Rosch, PJ, Markov, MS, eds. Bioelectric Medicine. Mineral Wells, TX: Marcel Dekker, Inc.; 2004: 3-27. Available at: .
Accessed December 6, 2006.
2. Smith RB. Scientific electromedicine. Positive Health. September 2003: 8.
3. Kirsch DL. A practical protocol for electromedical treatment of pain: cranial electrotherapy stimulation. In: Kirsch, DL, ed. 6th ed. Pain Management: A Practical
Guide for Clinicians. Boca Raton, FL: Greenwood Press; 2002: 1-6. Available at: .
Accessed December 6, 2006.
4. Smith RB. Scientific electromedicine. Positive Health. September 2003: 8.
5. Kirsch DL. A practical protocol for electromedical treatment of pain: cranial electrotherapy stimulation. In: Kirsch, DL, ed. 6th ed. Pain Management: A Practical
Guide for Clinicians. Boca Raton, FL: Greenwood Press; 2002: 1-6. Available at: .
Accessed December 6, 2006.
6. Gilula M, Barach P. Cranial electrotherapy stimulation: a safe neuromedical treatment for anxiety, depression, or insomnia. Southern Medical Journal. 2004; 12:1269-1270.
7. Kirsch DL, Giordano, J. Cranialelectrotherapy. Natural Medicine. 2006; 23:118-120. Available at: . Accessed December 6, 2006.
8. Kirsch, DL. A practical protocol for electromedical treatment of pain: cranial electrotherapy stimulation. In: Kirsch, DL, ed. 6th ed. Pain Management: A Practical
Guide for Clinicians. Boca Raton, FL: Greenwood Press; 2002: 1-6. Available at: .
Accessed December 6, 2006.
9. Kirsch, DL. A practical protocol for electromedical treatment of pain: cranial electrotherapy stimulation. In: Kirsch, DL, ed. 6th ed. Pain Management: A Practical
Guide for Clinicians. Boca Raton, FL: Greenwood Press; 2002: 1-6. Available at: .
Accessed December 6, 2006.
10. Klawansky S, Yeung A, Berkey C, Shah N, Phan H, Chalmers, TC. Meta-analysis of Randomized controlled trial of cranial electrostimulation. Efficacy in treating selected psychological and physiological conditions. Journal of Nervous and Mental Diseases. 1995; 7:478-484.
11. Ferjallah MB, Francis X, Barr RE. Potential and current density distributions of cranial electrotherapy stimulation (CES) in a four-concentric spheres model. IEEE Transactions on Biomedical Engineering. 1996; 939-943.
12. Schroeder M, Barr R. Quantitative analysis of the electroencephalogram during cranial electrotherapy stimulation. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology. 2001; 11:2075-2083.
13. Giordano, J. How alpha-stim cranial electrothrerapy stimulation (CES) works.
Alpha – Stim Technology Web site. Available at: http://alphastim.com/Information/Technology/Giordano/how_ces_ works.html.
Accessed December 18, 2006.
14. Neuroscience for Kids. The autonomic nervous system. Neuroscience for Kids Web site. Available at: http://faculty.washington.edu.chudler/auto.html. Accessed December 17, 2006.
15. Giordano, J. How alpha-stim cranial electrothrerapy stimulation (CES) works.
Alpha – Stim Technology Web site. Available at: http://alphastim.com/Information/Technology/Giordano/how_ces_ works.html.
Accessed December 18, 2006.
16. Kirsch DL, Smith RB. Cranial electrotherapy stimulation for anxiety, depression, insomnia, cognitive dysfunction, and pain: a review and meta-analysis. In: Rosch, PJ, Markov, MS, eds. Bioelectric Medicine. Mineral Wells, TX: Marcel Dekker, Inc.; 2004: 3-27. Available at: .
Accessed December 6, 2006.
17. Klawansky S, Yeung A, Berkey C, Shah N, Phan H, Chalmers TC. Meta-analysis of Randomized controlled trial of cranial electrostimulation. Efficacy in treating selected psychological and physiological conditions. Journal of Nervous and Mental Diseases. 1995; 7:478-484.
18. Gilula M, Barach P. Cranial electrotherapy stimulation: a safe neuromedical treatment for anxiety, depression, or insomnia. Southern Medical Journal. 2004; 12:1269-1270.
19. Gilula M, Barach P. Cranial electrotherapy stimulation: a safe neuromedical treatment for anxiety, depression, or insomnia. Southern Medical Journal. 2004; 12:1269-1270.
20. Barret R. “Be wary of nutripax and the nutripax network”. Quackwatch Web site. Available at: http://www.quackwatch.org/01QuackeryRelatedTopics/ces.html.
Accessed November 21, 2006.
21. Klawansky S, Yeung A, Berkey C, Shah N, Phan H, Chalmers, TC. Meta-analysis of Randomized controlled trial of cranial electrostimulation. Efficacy in treating selected psychological and physiological conditions. Journal of Nervous and Mental Diseases. 1995; 7:478-484.
22. Kirsch DL. A Practical protocol for electromedical treatment of pain: cranial electrotherapy stimulation. In: Kirsch, DL, ed. 6th ed. Pain Management: A Practical Guide for Clinicians. Boca Raton, FL: Greenwood Press; 2002: 1-6. Available at: .
Accessed December 6, 2006.
23. Klawansky S, Yeung A, Berkey C, Shah N, Phan H, Chalmers, TC. Meta-analysis of Randomized controlled trial of cranial electrostimulation. Efficacy in treating selected psychological and physiological conditions. Journal of Nervous and Mental Diseases. 1995; 7:478-484.
24. Elixa Peak Being. Cranial electrical stimulation (CES) for neurotransmitter balancing, mood control, IQ gains, sleep, exploration of altered states, peak performance, and much more. Elixa Peak Being Web site. Available at: http://www.elixa.com/estim/CES.htm
Accessed November 21, 2006.
25. Kirsch DL. A Practical protocol for electromedical treatment of pain: cranial electrotherapy stimulation. In: Kirsch, DL, ed. 6th ed. Pain Management: A Practical Guide for Clinicians. Boca Raton, FL: Greenwood Press; 2002: 1-6. Available at: .
Accessed December 6, 2006.
26. Kirsch DL, Giordano, J. Cranialelectrotherapy. Natural Medicine. 2006; 23:118-120. Available at: . Accessed December 6, 2006.
27. Collins WG. Book review: the science behind cranial electrotherapy stimulation. NeuroRehabilitation. 2000; 2:123.
28. Kirsch DL, Giordano J. Cranialelectrotherapy. Natural Medicine. 2006; 23:118-120. Available at: . Accessed December 6, 2006.
29. Kirsch DL, Smith RB. Cranial electrotherapy stimulation for anxiety, depression, insomnia, cognitive dysfunction, and pain: a review and meta-analysis. In: Rosch, PJ, Markov, MS, eds. Bioelectric Medicine. Mineral Wells, TX: Marcel Dekker, Inc.; 2004: 3-27. Available at: .
Accessed December 6, 2006.
30. Aetna clinical policy bulletin. Transcranial magnetic stimulation and cranial electrical stimulation. August 29, 2006. Aetna Web site. Available at: http://www.aetna.com/cpb/data/CPBA0469.html. Accessed December 16, 2006.
31. Elixa Peak Being. Cranial electrical stimulation (CES) for neurotransmitter balancing, mood control, IQ gains, sleep, exploration of altered states, peak performance, and much more. Elixa Peak Being Web site. Available at: http://www.elixa.com/estim/CES.htm
Accessed November 21, 2006.
32. Barret S. “Be wary of nutripax and the nutripax network”. Quackwatch Web site. Available at: http://www.quackwatch.org/01QuackeryRelatedTopics/ces.html.
Accessed November 21, 2006.
33. Tan G, Alvaraz JA, Jensen M. Complementary and alternative medicine approaches to pain management. Journal of Clinical Psychology. 2006; 11:1419-1431.
34. Gilula M, Barach P. Cranial electrotherapy stimulation: a safe neuromedical treatment for anxiety, depression, or insomnia. Southern Medical Journal. 2004; 12:1269-1270.
35. FDA: U.S. index to drug specific information. U.S. Food and Drug Administration – Center for Drug Evaluation and Research Web site. November 20, 2006. Available at: http://www.fda.gov/cder/drug/DrugSafety/DrugIndex.htm. Accessed November 22, 2006.
36. Gilula M, Barach P. Cranial electrotherapy stimulation: a safe neuromedical treatment for anxiety, depression, or insomnia. Southern Medical Journal. 2004; 12:1269-1270.
Eileen Jones, RN, MPH
Eileen Jones, RN, MPH, is an experienced registered nurse from Anchorage, Alaska. She holds a Master in Public Health with specialty in health promotion and education. Over the years, she researched and written over 40 hospital policies, as well as student modules, school papers, and a public information brochure.19 Responses
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The human brain is the most complex organ in the body. Neurostimulation is the next frontier in treating various froms of mental illness, including depression. It is the electricity that allow these therapies to target key areas of the brain responsible for mood and depression.
Unfortunately, third party payers( insurance companies) have discrminated against depression sufferers from having access to these medical breakthrough therapies.
The FDA approved vagus nerve stimulation therapy as an adjunctive treatment for chronic depression. Reimbursement decisions by private health plans have been on a case-by-case basis. At least 250 insurance plans have reimbursed for at least one case of vagus nerve stimulation therapy.
I sincerely believe that by year-end 2007, most insurance plans will universally reimburse for this treatment. The clinical benefits of vagus nerve stimulation therapy have been remarkable in the most difficult to treat cases of depression.
I would encourage readers to visit:
VagusNerveStimulation.com
It could change your life or the life of someone you love. The therapy changed my life.
I’d LOVE for this to work but the majority of articles you cite makes you look like you work for Alpha-Stim of stopdepressionnow.com. If this worked so well, wouldn’t we be seeing it “prescribed” (you can buy these devices from many sources without a script) more often. I’ve been combing the net and have only found spotty anecdotal information. I’m still skeptical.
Charles, what does Vagus Nerve Stimulation (VNS) have to do with these little 9-volt CES devices? Doesn’t VNS require a surgical operation?
I work for thirty years in a hospital, as an engineer for medical equipments and I am interested both in new medical technologies and in their applications and results. From this point of view I find this article very interesting.
This new treatment is quite a great discover, but I heard though that the doctors aren’t yet sure about some other effects that this may have on the body. Anyway… I still don’t see what else can be worse than the bad consequences that a drug, no matter what it is, has on an addicted person.
Timada
Is this just treatment or is a cure for depression, insomnia and anxiety? How can you treat or cure a spiritual illness?
Cranial Electrical Stimulation (CES) for neurotransmitter balancing? How long will the effect last? My neurotransmitters have been fried after a nasty traumatic experience. I got about 20% of serotonin left in my brain. You just want to kill yourself when you can’t just sleep a single second of your life ever again.
Show us real research, Ms. Jones. Good studies published in reputable, peer-reviewed journals. It looks to me that you either work for them or you fell for it.
Neurologist made me a Nuclear Magnetic Resonance, then It showed the presence of a left temporal pole aracnoidal cyst. Its size is 42x11x22 mm. Five years ago I was made another Resonance. Camparing both resonances, doctor appreciate that size cyst did not grow up with time. There is no presence of lesions in brain. I have never experimented convulsion and my relatives neither.I have no relatives with neurological illneses. Doctor told me that many people have with aracnoidal cysts and there is no problem, and they do not generally produce problems. Hence he diagnosed me depression, in adittion i have insomnia.
Can I use Alpha stim having a cyst?
My ex did this, and I payed for it, so that she could get off of the anti=depressants. Well, she did go down from 60 mg to 40,but, after her “treatments” she lost all interest in sexuality.
I even went so far as to tell her to get a new boyfriend, thinking that the root cause was emotional, but I was wrong.
That brain zapping thing Murdered her Libido.
Personally, I must say that more research should be done before the general public is told “don’t worry, this is safe”.
To all of the quacks out there who are advisesing their patients to do this, just stop !
This procedure is nothing short of a full frontal labotomy, with a fancy new name.
I too have experienced major loss of libido after a weeks use of the machine. I’m trying to do as much research here now to see what can be done to restore it but I am glad I am not the only one.
If anyone else has experienced loss of sex drive from this CES device please let me know if this goes away or what can be done to fix it. It is very disturbing that this device is marketed as safe and side-effect free.
Thanks,
I’ve used CES with hundreds of patients, and I’ve never had anyone report sexual side effects (with the exception of one person who reported that it increased libido…which she quite enjoyed).
Sexual side effects have never been reported in the literature. However, it is fair to question how closely side effects were monitored in the research.
Sexual side effects are a very well known, and frequently observed, side effect of antidepressants, however. These include loss of libido and inability to achieve orgasm.
In one of the cases described, the individual was on antidepressants, and was attempting to reduce them, at the same time as the CES was introduced. I’d suggest that it’s at least possible, and more probable, that the antidepressants were the source of the loss of libido.
In the other case, there’s no mention of whether or not antidepressants were used. However, most people try medication before they end up on CES. It’s at least possible that the actual problem was medication in this case as well.
I urge people to read the book, “Anatomy of an Epidemic” for a good review of the impact of psychiatric medication. Although CES is by no means perfect, it is clear that it has far fewer side effects than antidepressants.
Are there any effective reviews of CES devises you may have heard of . There is large range of prices and am wondering if I need to spend $700 on a device or if I can get away with $300.00 instead.
I’ve used the Alpha-Stim products and the CES Ultra (sold as Sleep Genie in Canada). Both work, and there’s no research which proves one is better than the other. However, it’s my opinion based on clinical and personal experience that the Alpha-Stim products are more effective. That being said, it’s a VERY big price difference. Is there a difference between a Corvette and a Sunfire? You bet. Is it worth the difference? It is if you can afford it. But both will get you from A to B!
The Alpha-Stim products use a 0.5 Hz setting, and have a unique waveform; you can really feel the difference when you compare them, but of course, most people won’t have that chance.
The CES Ultra is a perfectly good machine, though, and I get good results with it. But if you can afford it…go for the Alpha Stim Aid. Which, granted, is more than twice as much money.
Also, the Alpha Stim products have a 5 year warranty, and the new redesign of them makes them much more user-friendly than they used to be.
Thanks Quaze, that is helpful. Can I ask you what makes the Alpha Stim better? I am suffering from insomnia and am in need of relief but not thrilled at spending $800.00 for what is essentially an experiment but would if I knew what the benefit was to me.
I would do anything to get 7 hours of sleep.
The much slower Hz of the 0.5 seems to be more calming, in my opinion, though some people dislike it–if you have it turned up too high, you’ll feel dizzy or nauseous. Personally, I love the effect, though I have had people prefer the CES Ultra to the Alpha Stim. In other words, it’s a bit subjective, and I’ve got no data to back up the assertion that AS is better. It’s just an impression…though an educated one.
In your case, it might make sense to try the CES Ultra first. You should be able to get good results within the window of their return policy. If that’s not sufficiently helpful, send it back, and plunk down the extra dough for the Alpha Stim.
While it is true that nothing works for everyone, insomnia definitely responds well to CES, and CES is a non-addicting, non-drug alternative that, in my opinion, should be tried BEFORE medication, given that it’s safer. However, don’t expect it to be exactly like medication. It’s relaxing, not sedating–it’s NOT going to knock you out. It tends to be more helpful with initial insomnia than with middle and late insomnia (though if you wake up in the middle of the night, good sleep hygiene consists of getting out of bed rather than tossing and turning anyhow–which gives you an excellent opportunity to use your machine again).
So while it will be an experiment for you, bear in mind that CES has been proven time and time again to have no significant placebo effect!
Thank you so much for you opinion. Very helpful Quaze.