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Cranial electrotherapy stimulation (CES) is a US Food and Drug Administration–approved, prescriptive, noninvasive electromedical treatment that has been shown to decrease anxiety, insomnia, and depression significantly.
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Side effects from CES are mild and self-limiting (<1%); these include vertigo, skin irritation at electrode sites, and headaches.
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A functional magnetic resonance imaging study showed that CES causes cortical deactivation, producing changes similar to those produced by anxiolytic
Cranial Electrotherapy Stimulation for Treatment of Anxiety, Depression, and Insomnia
Section snippets
Key points
Neurophysiologic effects and research studies
The brain functions electrochemically and can be readily modulated by electrical intervention. Research conducted at the Biomedical Engineering Program of the University of Texas at Austin indicated that from 1 mA of current, about 5 μA/cm2 of CES reaches the thalamic area at a radius of 13.30 mm and may facilitate the release of neurotransmitters, which in turn could cause physiologic effects such as relaxation.1 CES is believed to affect the subcortical brain structures known to regulate
Clinical considerations and guidelines
To integrate CES into the practice of psychiatry for the treatment of anxiety, posttraumatic stress disorder, depression, and insomnia, the authors recommend a trial series of treatments in a clinic or office to evaluate responses in each individual. After the initial trial, patients can be prescribed a CES device to use at home, giving them increased control over the management of their symptoms. In addition to a regular 20- to 60-minute treatment daily or every other day, patients can add
Evaluating immediate and long-term effects
Feelings experienced during a CES treatment are shown in Fig. 1. If the patient feels heavy, groggy, or euphoric at the end of the allotted time, it is important to continue the treatment session until the patient feels “light.” At the end of a CES session, most patients will feel more relaxed, yet alert, and have an increased sense of well-being.
Evaluating a single 20- to 40-minute trial of CES in a clinic or office will help identify those individuals who most readily respond to CES. However,
Contraindications, precautions, and adverse effects of cranial electrotherapy stimulation
There are no known contraindications to the use of CES. The only precaution is regarding use during pregnancy. A study of potential teratogenic effects from CES was conducted on 844 Spraque-Dawley fetal rats.22 The treated rats were divided into 3 groups and given CES 1 hour daily throughout their pregnancy at either 10, 100, or 1000 Hz, while the parameters of 1 V, 0.125 mA, at a 0.22-microseconds pulse width remained constant. On day 18 of pregnancy, the dams were killed and cesarean section
Summary
CES can improve the safety and efficacy of treatment of anxiety, insomnia, and depression. When prescribed for home use, patients are empowered to regulate their own moods and to overcome their sleep problems, thus enhancing patient outcomes. Compared with other neuerostimulation techniques for brain repair, CES is noninvasive and less expensive and can be used safely and conveniently by patients at home. It is useful as an adjunct to medication or psychotherapy or as a stand-alone treatment.
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Conflict of Interest: D.K. is Chairman of Electromedical Products International, Inc; F.N. is Research Consultant for Electromedical Products International, Inc.