Tag Archives: cranial electrical stimulation

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.

ces-treat-anxiety

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.

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.

ces-alternative-to-drugs

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 – https://www.cesultra.com/research-resources.php

CES and the aging brain

There is a growing body of evidence suggesting that the aging brain undergoes neuroplastic changes to respond to functional declines and keep performance on the best level. During these changes, additional brain areas are recruited, such as the ipsilateral motor cortex. First proof of principle has been provided that CES might modulate cortical functions even in old subjects. Nevertheless, this exciting and progressing field is still at a starting point and more studies are needed to further substantiate the hypothesis that CES can be used to enhance functions that have declined with age. In comparison to pharmacological interventions, CES is applied focally and does not have systemic side effects, a crucial point to consider in this population. Moreover, these techniques are easy to apply and can be coupled with training protocols or rehabilitative programs, such as physio-, occupational, speech therapy, or gait training to enhance impaired functions with a consecutive improvement of quality of life.

cesultra-old-people

CES has been shown to reduce the levels of stress hormones

There are numerous CES studies in which CES has been shown to reduce the levels of stress hormones in the body. Usually this reduction is found to be in connection with a rebalanced relationship between stress related hormones and other hormones with which they are normally in balance in non stress states.

For example, Pozos and his team found that CES could bring back into homeostatic balance the neurotransmitter dopamine that had been deliberately thrown out of balance in an animal preparation, thus removing Parkinson like symptoms that he had induced with the imbalance earlier.

Gold and his coworkers found that CES could bring back into homeostatic balance the endorphin-norepinephrine system in the brains of withdrawing human addicts, thus eliminating the major stress of the drug abstinence syndrome.

Similar results were found in an animal preparation by Dougherty and his coworkers at the University of Texas.

Shealy studied stress hormones specifically in a group of 164 patients who were severely depressed and found abnormal levels of melatonin, norepinephrine, beta-endorphin, serotonin and cholinesterase ranging widely throughout the group.

Since similarly depressed patients had routinely responded well to CES in the past, he selected another group of 37 chronic pain patients whose pain was nonresponsive to usual treatments, and who were also depressed. He studied their stress hormone levels before and following CES treatment. He found pre-post changes in serotonin, beta-endorphin, norepinephrine and cholinesterase in the patients following stimulation with CES, 20 minutes a day for two weeks. Forty-four percent of the chronic pain patients reported significant improvement in their pain and required no additional treatment. The depressed patients reported 50% clinical improvement in their depression, often bringing them back within the normal range.

In searching for the mechanism with which CES induced these changes, Shealy studied the cerebral spinal fluid (CSF) vs. blood plasma in 10 normal subjects prior to and following 20 minutes of CES stimulation. He found changes in melatonin, serotonin, norepinephrine, beta-endorphin and cholinesterase in both the CSF and blood plasma, but with greater changes in the blood plasma, in each instance. He concluded that CES activated a hypothalamic response that resulted in a body-wide change in the levels of those stress realted biochemicals.

While inflammation was not measured in the above studies, in so far as stress hormones can engender the inflammation response CES could be inferred to be a significant treatment in reducing inflammation in the body, along with the myriad medical pathologies that accompany it.

As a typical follow on to stress engendered inflammation, Ware notes that psychological stress and depression have been established as important risk factors for coronary heart disease, while Cassels found that approximately 30% of adults with diabetes have comorbid depression, which is associated with poor metabolic control, more complications, increased healthcare use and costs, reduced quality of life, greater disability and lost productivity, and higher mortality rates.

CES Ultra as a modern “electrosleep” device

Cranial Electrotherapy Stimulation (CES) is the American FDA’s term for what the rest of the world calls “electrosleep.” Modern electrosleep devices originated in Russia in 1953, and arrived in the U.S. ten years later, in 1963, when they began to be researched with patients complaining of insomnia.

Various uses of small to moderate electrical currents had been researched since the early 1900s in Europe, in an attempt to see exactly what current intensity and pulse rate were required to put a patient to sleep when applied to the head. By that, they meant what was required to knock him out or force him to lose consciousness and maintain the patient in that state for a period of time. Researchers finally gave up on finding a specific type of current that would reliably put most patients to sleep. Unlike those earlier models, modern CES devices are typically pocket sized, run off of a 9 volt battery, and pulse from 100 up to 15,000 times per second. The current intensity usually is at or just below 1 mAmp, but can go up to 4 mAmp with higher pulse rates. Most would just light a flashlight bulb at best, and in the majority of clinical studies, patients have not felt the stimulation at all during treatment.

In the early 1950s Russian medical researchers were working with these very low levels of current, which they applied via two electrodes attached to the closed eyelids and two attached behind the head at the base of the skull. They were attempting to find a psychiatrically useful current, and while the current level was much too low to force a person into a sleep state, they found to their great interest that patients were claiming vastly improved sleep during nights following sessions when these very minor amounts of stimulation passed across the head. They then began studying this effect specifically, and in 1953 finally came out with the Somniatron electrosleep device.

Several similar devices were later manufactured in the U.S. for research purposes, and their clinical use began among inpatient and outpatient psychiatric patients, usually in University Teaching Hospitals. Several other Universities began research with animals in an effort to see if CES really did change how the brain functioned, if it was safe to use, and what the mechanism of action might be.

They found that the current traveled throughout the brain, that it increased production and firing of neurotransmitters in neurons,3 and that when researchers deliberately threw neurotransmitters out of balance in the brain, electrosleep would put them back in balance. Other researchers found that electrosleep would apparently also put back into balance neurotransmitters in human patients whose neurotransmitters had been thrown out of balance by various addicting substances.

By Ray B. Smith, Ph.D