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A View from the Trenches: Why Psychiatry needs CES – Part 1

Why Psychiatry needs CES
by Jason Worchel, M.D.

Jason Worchel, M.D. is a noted psychiatrist and Director of the Hilo Mental Health Center in Hilo, HI. The following posts are taken 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.

The Challenge of Psycho-Pharmacology

As a practicing psychiatrist, I am constantly struggling with balancing purported efficacy with known risks of somatic interventions. While currently approved interventions have demonstrated efficacy relative to placebo, the rate of improvement with placebo remains consistently above 30%.

With the increasing prevalence of polypharmacy, there is an increasing risk of adverse side effects for the statistical hope for improved outcomes as demonstrated in clinical trials conducted with select populations in controlled environments. In addition to evaluating the risk/benefits of various treatments, I know from multiple studies most patients are not adherent to the prescribed medication regimens and discontinue medications altogether within a relatively short period of time.

Though my goal is to treat the presenting illness or alleviate its symptoms, my primary duty to my patients is to “do no harm.” This typically results in an approach that follows a spectrum of interventions with initial treatments being those with the least risk of adverse side effects.

There is no risk conventional interventions that currently constitute the standard of care will be bypassed by using CES.

Experience

I have worked with primary care physicians in our federally qualified health clinics on the Big Island. They, like others across the country, are stymied and frustrated by the challenge of treating chronic pain.

In particular, they face patients with bona fide pain but who also have depression, anxiety, insomnia and substance abuse. With regards to treatment interventions, they are damned if the do and damned if the don’t treatment with various classes of analgesic medications, including narcotic medications.

They are particularly afraid of the increasing fatalities occurring with the use of narcotic analgesic medications in combination with benzodiazepines and antidepressant medications. They welcome alternatives to medications for those patients whose emotional distress intensifies their suffering and pain sensation. CES could provide a safe alternative for them that do not currently exist.

In summary, CES represents as safe intervention for conditions for which existing treatments, especially pharmacologic and invasive interventions pose significant risk for adverse side effects. It is especially beneficial in defined populations. These include those who refuse medications and psychotherapy, dual diagnosed patients, geriatric patients, females of child bearing age and during pregnancy.

Advantages of CES

I would like to highlight various advantages of CES relative to other existing treatments, especially medications that may not be well appreciated. Take for example, the difficulty faced by primary care physicians and mental health professionals in treating female patients of child bearing age. All available medications have teratogenic risk and are not recommended during pregnancy and breast feeding. Patients desiring to become pregnant have justified concerns about taking psychotropic medication

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Current treatment algorithms encourage polypharmacy when initial treatments with a single drug are not effective. While there is some increased response, polypharmacy only increases the side effects burden and can result in untoward drug/drug interactions. These types of problems do not occur with CES.

Many psychotropic medications for the treatments of depression, anxiety and insomnia have discontinuation syndromes. Given the high rate of discontinuation of these medications by patients due to side effects and lack of efficacy, many patients unfortunately suffer when the take a medication prescribed to alleviate their suffering. This does not occur with CES. There are circumstances, for example prior to surgery, when certain psychotropic medications are required to be discontinued. CES does not have to be discontinued prior to surgery.

One my greatest concerns in treating patients with depression, anxiety and insomnia involves suicide. We know increased risk of suicide in depressed patients but it is often global insomnia is a significant risk factor for suicide as well as anxiety/agitation. Although safer than the older tricyclic and tetracylcic antidepressants, the current medications carry a significant risk of death in overdose, especially when combined with other analgesic medications. Too often, the medications we prescribed to prevent suicide become a means through which the patient attempts suicide. In fact, there are black box warnings that these medications may increase suicidal impulses, especially in adolescents. CES does not pose this risk.

As in many developed countries, we are an aging population. The treatment of depression, anxiety and insomnia in the geriatric patients with medications present unique challenges due to the increased risk of adverse side effects. These side effects include the risk of falls and motor vehicle accidents. Again, the number of medications taken in our geriatric patients continues to increase. Thus risk of adding psychotropic medications to their other medications poses additional drug/drug interactions and side effect burden.

CES avoids this disadvantage and provides a safe alternative to patients, their families and care givers. Furthermore, missing a CES treatment does not carry the risks of missing doses of psychotropic medications in this population.

CES Ultra research – read more – http://www.cesultra.com/research-resources.htm

A View from the Trenches: Why Psychiatry needs CES – Part 2

Anxiety

There are 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 which suffers from anxiety. These persons instead seek medications from their physician to alleviate their suffering.

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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 problems with the other classes of medications.

A serious potential side effect of benzodiazepines is 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 of medications can result in compromised coordination, slowed reaction time, falls, disinhibition, delirium, and anterograde amnesia.

It is not uncommon to see suicide attempts involving a combination of a benzodiazepines together with alcohol and/or another sedative hypnotic. While buspirone is relatively well tolerated, it has poor efficacy and a 3 to 4 week lag time to have an effect. Medications such as gabapentin are used off label but there is no research to support its efficacy for anxiety disorders.

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.

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.

CES as an effective treatment for pain

Cranial Electrotherapy Stimulation, which has been in use around the world since the early 1950s is an FDA recognized treatment of anxiety, depression and insomnia.  Many patients and their physicians have also discovered that it is a very effective treatment for pain.

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It has been theorized that CES is effective in pain treatment because it is known to relieve stress, and stress is known to be a strong correlate of the perception of pain in pain patients.

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Recently it has been shown that pain is also a frequent accompaniment of depression, which CES is known to treat very effectively. In one study more than 75% of patients being treated for depression reported experiencing chronic, or recurring pain, and 30% to 60% of pain patients studied, also reported significant depression.

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Presented by cesultra.com

Why Psychiatry needs CES

The prime directive – Do No Harm

The primary duty to patients should be to “do no harm”. Avoiding harm typically results in an approach that follows a spectrum of interventions beginning with treatments that pose the least risk of adverse side effects.

The harm reduction approach increases the likelihood patients will benefit without being exposed to unnecessary risks of harm. CES should be included in the spectrum of available treatments as it poses very low risk of harm to patients.

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CES as a safe and effective alternative

People worried about the use of pharmaceutical drugs should consider CES as a safe and effective alternative

The FDA has expressed concern as to utilization of CES without first employing more “conventional” treatments. Unfortunately, the more conventional treatments at times are not only ineffective but also in many circumstances contribute to a worsening of the condition or result in deleterious side effects.

This can result in necessary therapeutic alliance adversely impacted. Frequently, patients will mention the advertisements they see on television by various attorneys soliciting patients who have been harmed by approved medications, ECT or other treatments. They are worried about being harmed by prescribed treatments and become suspicious of their health care professionals.

There is excellent data and clinical experience however to support the safety and lack of adverse side effects from CES and it should be included in the spectrum of available treatments as it poses very low risk of harm to patients.

Excerpts from “A View from the Trenches” written by Jason Worchel, M.D.

More CES Research – http://www.cesultra.com/research-resources.htm

Why is a New Treatment for Depression so Essential? And How the CES Ultra May Be the Answer

Depression in adulthood remains a common and often under-treated condition.

Depression can occur at any age, but it typically emerges in the mid-20s. Women experience depression twice as frequently as men, and symptoms can vary from mild to severe. Major depressive disorder, which may be diagnosed when depressive symptoms last for 2 weeks or more, is understood to occur in 15 to 17 percent of the population.

Symptoms of major depressive disorder can include a depressed mood, loss of interest and enjoyment, reduced energy, increased fatigue, diminished activity and reduced concentration and attention.

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These and other symptoms, particularly when prolonged, impair a person’s ability to function in day-to-day life, making effective treatment essential.

Research continues to improve our knowledge about the impact of depression on our ability to process information and the underlying processes in the brain that are associated with depressive symptoms.

With increased information, psychologists and mental health professionals have made significant progress in identifying effective treatments.  A combination of cognitive behavioral therapy and medication has evolved the most effective treatment to date.

However, it is not fully understood exactly how and why antidepressants work. And despite significant advancements in medications, treating major depressive disorder remains a challenge. Although medication helps, it can be costly and produce troublesome side effects.

Recent Advances in Electrical Treatments

Noninvasive brain stimulation, such as CES have been increasingly investigated for the treatment of major depression.

Long-term depression happens over a period of time, but now you can get your brain to work for you again. The CES Ultra, using Cranial Electrotherapy Stimulation (CES), can bring you true relief. It’s a proven way to treat feelings of depression—without using drugsStudies show that approximately 70% of people with depression who use the CES Ultra find 70% relief of their symptoms.

You can use the CES Ultra while still on your medication. In fact, don’t go off your medication until your doctor says so. With the CES Ultra, you also have personalized telephone support to ensure that you get the full relief and results. CES has no withdrawal symptoms, as most drugs do. Explore its possibilities today.