Tag Archives: insomnia treatment

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

cesultra, ces ultra, cranial electrotherapy How To

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.

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.

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

Why You Shouldn’t Reach For a Sleeping Pill When You Can’t Sleep

Chronic lack of sleep has a cumulative effect when it comes to disrupting your health, so you can’t skimp on sleep on weekdays, thinking you’ll “catch up” over the weekend. You need consistency. Generally speaking, adults need between six and eight hours of sleep every night. There are plenty of exceptions though. Some people might need as little as five hours a night, while others cannot function optimally unless they get nine or 10 hours.

Find how Sleep Better With CES Ultra

cesultra-sleep

My strong recommendation and advice is quite simply to listen to your body. If you feel tired when you wake up, you probably need more sleep. Frequent yawning throughout the day is another dead giveaway that you need more shut-eye. Personally, I find that when I am reading during the day, if my eyes close and I tend to doze off, I know I did not get enough sleep the night before. However, above all, should insomnia strike, don’t make the mistake of reaching for a sleeping pill.

Not only do sleeping pills not address any of the underlying causes of insomnia, researchers have repeatedly shown that sleeping pills don’t work, but your brain is being tricked into thinking they do… One analysis found that, on average, sleeping pills help people fall asleep approximately 10 minutes sooner, and increase total sleep time by a mere 15-20 minutes. They also discovered that while most sleeping pills caused poor, fragmented sleep, they induced amnesia, so upon waking, the participants could not recall how poorly they’d actually slept!

In terms of health consequences, this could end up being worse than not sleeping and being aware of that fact. At least then you’d be encouraged to find and address the root cause of your sleeplessness. Besides not working as advertised, sleeping pills have also been linked to significant adverse health effects, including a nearly four-fold increase in the risk of death, and a 35 percent increased risk of cancer.

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”.

ces-treats-depression

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.

ces-treats-insomnia

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.