Category Archives: Depression

CES Ultra is a non-drug approach to treatment of depression

Cranial Electrotherapy as alternative to drugs for depression treatment

New treatments for depression offer hope

According to the National Institute of Mental Health, nearly 7 percent of adults in the U.S. have been diagnosed with depression, costing employers anywhere between $17 billion to $44 billion as a result.

Then there are those who never get diagnosed because they never seek treatment for their depression – even though there are plenty of treatments available today that have been very successful in combating its symptoms.

Some of the treatments for depression that have proven to be effective include a wide variety of therapies, ranging from talk therapy and anti-depressant medications, to meditation and walking in the park.

The key to any successful treatment, however, requires patience because it can take 4 to 6 weeks for the anti-depressants to kick in. It also takes time to tweak dosages or otherwise switch to a different-acting anti-depressant if the first one was not effective.

But good news exists for depression, as much progress has been made, not just in treating it, but in understanding the underlying dynamics that contribute to the condition.

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As a result, there are a variety of new treatments for depression that are on the horizon, including the following:

Cranial electrotherapy stimulation (CES) – CES administers small electric pulses across a patient’s head using a portable, battery-powered device that can be used at home. Approved by the FDA, CES provides relief from symptoms of insomnia, anxiety and depression. It is also approved for treating chronic pain.

Transcranial magnetic stimulation (TMS) – TMS involves a series of brief magnetic pulses to the brain, which are administered through an electromagnetic coil adjacent to a patient’s scalp. The pulses stimulate certain circuits in the brain that are underactive depressed patients. The goal of TMS is to activate these targeted areas of the brain to alleviate depressive symptoms and restore the brain to normal functioning.

Deep brain stimulation – Unlike other brain stimulation treatments, deep brain stimulation involves the surgical placement of a battery-operated neuro-stimulator, which is used to treat a variety of neurological symptoms. The implant is similar to a pacemaker, but instead of stimulating the heart muscle, it stimulates targeted areas of the brain. It is especially effective for patients with Parkinson’s disease, but is currently being tested for its effectiveness in treating depression.

SOURCES:
1. Psych Central, Depression: New Medications On The Horizon, Tartakovsky, M., retrieved February 4, 2014.
2. National Institute of Mental Health, Introduction: Mental Health Medications
3. Brain & Behavior Research Foundation, What is Depression?
4. Press Release: JayMac Pharmaceuticals Introduces EnLyte with Delta Folate: A Safe, Natural, & Complete Prescription Therapy For Depression, February 4, 2014.

A View from the Trenches: Why Psychiatry needs CES – Part 3

Depression

There is considerable controversy involving the efficacy of antidepressant medications.
The controversy also involves the risk/benefit analyses of currently approved interventions For example, Time magazine recently cited Kirsch’s meta-analysis in PLoS Medicine that found little benefit of antidepressants for most patients as well as Dr. John Krystal’s findings that about 25% of patients did worse on antidepressants than on placebo”.

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There are also many non-pharmacologic interventions for reducing anxiety. Some of these include dietary supplements, acupuncture, meditation, yoga, and exercise. These interventions, however, are not employed by a large segment of society that suffers from anxiety.

These persons instead seek medication from their physician to alleviate their suffering. Typical classes of medications for anxiety include the SSRI’s, benzodiazepines as well as the off label use of antihistamines and atypical antipsychotic medications and antiepileptic medications.

In addition to the inherent problems with SSRI’s, there are also serious problems with the other classes of medications. A serious side effect of benzodiazepines includes their potential for inducing physical and psychological dependence. In addition, withdrawal symptoms can prove life threatening, especially with the shorter acting benzodiazepines like alprazolam. When taken as directed, which is often not the case; this class can result in compromised coordination and slowed reaction, falls, disinhibition, delirium, and anterograde amnesia.

It is not uncommon to see suicide attempts using a combination of a benzodiazepine together with alcohol and/or another sedative hypnotic. While buspirone is relatively well tolerated, it has poor efficacy for many anxiety disorders and 3 to 4 week lag time to effect often leads to premature discontinuation.

Medications such as gabapentin are used off label for anxiety disorders but there is no research to support its efficacy. Unfortunately, physicians have begun using the atypical antipsychotic medications to treat anxiety. This class of medications has a large and increasing number of very serious side effects. Recent attention has been focused on their causing metabolic syndrome.

They frequently cause extra pyramidal side effects, sedation, elevated prolactin levels and drug/drug interactions. All of these medications should be avoided during pregnancy and used with caution in the elderly. In short, the side effect profile of current pharmacologic treatments for anxiety limits their safe use. CES is a safe, initial alternative to such medications.

Insomnia
Many patients benefit from improving sleep hygiene as a treatment for insomnia. Others may improve using a sleep phase changes or treating the underlying problem such as sleep apnea, medical conditions, alcohol abuse, etc.

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For many others, recent pharmacologic treatments prove effective and have minimal side effects. Targeting melatonin receptors is a novel and promising approach. For many persons, however, existing treatments are ineffective, too expensive, result in side effects or conflict with their desire to avoid medications.

Some side effects from medications are very disturbing, such as sleep associated behaviors that result in harm to self or others. For others, there is morning sedation, drug/drug interactions or rebound insomnia. When behavioral interventions are not effective, CES could be considered prior to initiating medications.

By Jason Worchel, M.D., a noted psychiatrist and Director of the Hilo Mental Health Center in Hilo, HI. This post is from a paper written by Dr. Worchel in his testimony before the F.D.A. concerning the effectiveness and safety of CES from the perspective of a practicing psychiatrist.

All LIkert Scales

All scales receive the score above the X that the patient placed on each line, with the exception of the Time to Go To Sleep, in which the score is from 0 to 10, with one minute scored 0 and 50+ minutes scored 10. To get the total score for each scale just add the scores of the individual items together.

The depression and anxiety scales can be used alone for the study of those disorders, or the depression scale can be used along with the hypomania scale to study emotion swings in bipolar patients.

All 4 LIkert Scales

download them as pdf files

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Statistical Note: These scales obviously force non linear data onto a linear scale for statistical handling. If groups of patients are studied pre and post treatment, it is best to let each group serve as its own control due to the error variance that can be best held constant in that manner

If a patient is to be individually clinically examined, then the percent change score as a result of treatment can be obtained by dividing the pre treatment score into the post treatment score and multiplying the result by 100.
Statistician. If a researcher wishes, he can email the scores in two separate groups, such as “group A” and “group B” to Ray Smith at ray.smith@Nastos.com, and he will do the statistical analysis and email the results back, usually within a couple of days.

Journal Write-up. If a researcher wishes, Dr. Smith will also write up the study for publication if the researcher will give him the name of the journal he wishes it published in so he can follow that journal’s author’s format.
Both of the above services are free for CES studies, though ethically, Dr. Smith has to append his name to the end of a published study he has been involved with.

Presented by cesultra.com

Cranial Electrotherapy Stimulation (CES) Vignette 1

Vignette # 1

John, a fourteen year old Caucasian male with a history of psychiatric treatment including medication intervention for depression and developmental deviation with a hyperkinetic element. His history of school functioning had been poor although he was not reported to display excessive body movement or squirminess difficulty attending was a problem. During the initial psychological evaluation on a measure of depression he scored at the 76th percentile, while on a measure of anxiety he scored at the 81st percentile with present moment (state) anxiety and at the 68th percentile with general proneness (trait) anxiety. On the Wechsler Intelligence Scale for Children-Revised (WISC-R) Full Scale intellectual functioning was in the Average range (Full Scale IQ = 108) with verbal area functioning also in the Average range (Verbal IQ = 107) and performance area functioning in the Average range
(Performance IQ = 107) as well.

After thirty days daily usage of at least forty-five minutes with the CES device he was again administered a psychological evaluation. On the same measure of depression John scored at the 74th percentile, while on the same measure of anxiety he scored at the 7th percentile with present moment (state) anxiety and at the 47th percentile with general proneness (trait) anxiety, a very noticeable decrease with his levels of anxiety. On the WISC-R Full Scale intellectual functioning was in the High Average range (Full Scale IQ = 114) with verbal area functioning in the Average range (Verbal IQ = 102) and Performance area functioning in the High Average range (Performance IQ = 126). Higher scores in the Performance area indicated a gain of more than three standard deviations which by chance alone would occur in less than two in ten thousand cases (p<.0002). These results were obtained even though John was physically ill during the post CES evaluation. In the psychologist's opinion there would have been more of an increase if he had been feeling better.

CES – a return to wellness

CES, by reducing depression and other signs of psychologically engendered chronic stress, may well play a significant role in reducing or eliminating psychogenic inflammation. That being the case, then another mechanism for the effectiveness of CES in reducing pain throughout the body, and engendering an overall return toward a state of wellness can be inferred. By reducing stress CES can rationally be implicated in assuaging or ameliorating all of the inflammation related medical conditions mentioned above, from diabetes to heart disease, stroke, and all of the various “itis” conditions, including pain.