Optimal functioning of the brain is an essential component of good mental health and well-being. In recent years, brain stimulation therapies have become increasingly popular as novel treatments due to the increased prevalence of treatment-resistant disorders and the lack of current treatment options available for patients with severe mental health conditions such as schizophrenia and bipolar disorder. The brain functions electrochemically, which means that neurons in the brain communicate via electrical and chemical mechanisms, and the use of electricity, magnets or implanted electrodes has become an increasingly popular way to activate and make changes to specific parts of the brain in patients affected by various psychiatric conditions.
The current treatments available for conditions such as anxiety, depression and insomnia are limited in their effectiveness, side effects and costs required for treatment. One novel brain stimulation technique, called cranial electrotherapy stimulation (CES), was approved by the U.S. Federal Drug Administration (FDA) as a Class III device for the treatment of depression, anxiety and sleep disorders such as insomnia. A proceeding is also pending for Class II status for use in people recovering from substance use disorders (SUDs), according to Mental Health America (MHA). In recent years, an increasing number of psychiatrists have integrated CES into mental health treatments as it is noninvasive therapy that has relatively few side effects (e.g., headaches).
How does cranial electrotherapy stimulation work?
Christopher Fisher, Ph.D., reported that CES falls under the branch of alternative medicine called electromedicine, which treats physical and psychological conditions using varying levels of electrical current. CES uses a small device that stimulates the brain with an electrical current via electrodes placed in the earlobes, maxilla-occipital junction, mastoid processes or temples. Fisher reported that the pulsed electrical currents administered during CES affect the limbic system, reticular activating system and/or hypothalamus and stimulate regions that control the production of neurotransmitters and hormones via the hypothalamic-pituitary-adrenal (HPA) axis.
Daniel L. Kirsch, Ph.D., from the American Institute of Stress, and Francine Nichols, R.N., Ph.D., reported that the use of CES can be used to produce neurophysiologic effects similar to those induced by anxiolytic (i.e., anti-anxiety) medications. They indicated that the following neurochemical changes have been found in the blood plasma of patients 20 minutes after a single CES session:
After therapy, many people report feeling a sense of calmness and deep relaxation, decreased anxiety and sadness and increased mental alertness. Previous research indicates that the adverse effects are mild and only last a limited period of time, most of which include dizziness, skin irritation and headaches. When a higher than necessary current is utilized, patients may experience more serious side effects such as dizziness, nausea, increased anxiety and sleep disturbances.
A potential treatment for bipolar disorder and PTSD
A study conducted by Alexander Bystritsky, M.D., and his colleagues (2008) evaluated the efficacy of CES in alleviating anxiety in 12 diagnosed with generalized anxiety disorder (GAD). The preliminary study suggested that CES may be useful for reducing symptoms of anxiety in GAD, with relatively few and mild side effects, which mostly consisted of headaches and nausea. Bystritsky and his colleagues suggested that CES could potentially exert its anxiolytic effects through its action on the thalamus and/or its afferent pathways, which could have important treatment implications for post-traumatic stress disorder (PTSD) and SUDs.
Researchers have found that the use of CES stimulates the parasympathetic nervous system, which counteracts the stress response, reduces physical symptoms (e.g., rapid pulse, shaking and sweating) and psychological symptoms (e.g., anxiety, restlessness, agitation, anger, depression and sleep problems), and improves emotional regulation (e.g., reduced impulsive and aggressive behaviors), making CES potentially useful for patients with PTSD, said Richard Brown, M.D., associate professor in clinical psychiatry at Columbia University College of Physicians and Surgeons.
The research available on the effectiveness for disorders like bipolar disorder are sparse, said James Phelps, M.D., director of the mood disorders program at Samaritan Mental Health in Oregon and bipolar disorder section editor for Psychiatric Times. Phelps reviewed the findings of a new pilot study that included 16 patients. Despite finding “positive” results found in the pilot study, he argued that these findings require careful examination and interpretation. Furthermore, due to the lack of studies available regarding the use of CES for patients with bipolar disorder, further study for CES as a possible alternative treatment is warranted, Phelps concluded.
Other recent studies examining the efficacy of CES have found evidence for CES in treating pain, headaches, fibromyalgia, smoking cessation and opiate withdrawal, and other substance use disorders (SUDs). CES has potential use for treating other mental health conditions, including PTSD and bipolar disorder, although there is a lack of research examining the safety and efficacy of CES for treating these conditions.
Although many studies have found brain stimulation therapies to have positive effects on patients with mental health conditions, the use of CES is still considered to be investigative for treating various mental health conditions. Although CES is currently only approved for treating depression, anxiety and insomnia, further empirical investigation could be important for providing support for its use for treating other mental disorders, including PTSD, SUDs and bipolar disorder. In the future, CES could be an important adjunctive or alternative treatment option for patients with severe or treatment-resistant disorders who have not experienced success with traditional treatments.
The Sovereign Health Group provides a holistic array of behavioral health treatment services to patients with substance abuse, mental illness and co-occurring disorders. To find out more about the treatment programs offered at Sovereign Health, please contact our 24/7 helpline to speak to a member of our team.
About the author
Amanda Habermann is a writer for the Sovereign Health Group. A graduate of California Lutheran University, she received her M.S. in clinical psychology with an emphasis in psychiatric rehabilitation. She brings to the team her background in research, testing and assessment, diagnosis and recovery techniques. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.