Cranial Electrotherapy Stimulation

Cranial electrotherapy stimulation (CES) is a US Food and Drug Administration–approved, prescriptive, noninvasive treatment that has been shown to significantly decrease anxiety, insomnia, and depression. In many cases, it decreases obsessive worry and increases focused attention. The very simple concept behind the device has been known for more than 40 years, and has been tested for safety and efficacy in double-blind, sham-controlled RCTs studies funded by the National Institutes of Health, Department of Defense, and Veterans Administration. At one time, it was known as electrosleep therapy.

What to expect

The device is about the size of a cell phone. It sends a pulsed, low-intensity electrical current to the brain via electrodes placed on the ear lobes. It is meant for use at home, but we have you try it in the office first as a small number of people do not enjoy the feeling (e.g. those with sensory sensitivities.)

Treatments need to be performed 1-2 times a day for 20 to 60 minutes during the first 3 to 4 weeks and then 2 to 3 times per week during a maintenance phase. An optimal time is three hours before bedtime. Each session can occur concurrently with other activities such as reading or working on a computer.

The CES device can be used as often as needed, as there are no side effects from extended use, which is especially beneficial for those individuals diagnosed with posttraumatic stress disorder and those who experience panic attacks.

If the you feel heavy, groggy or euphoric at the end of the allotted time, it is important to continue the session until you feel “light.” At the end of a CES session, most people feel more relaxed, yet alert, and have an increased sense of well-being.

CES treatments are cumulative; however, most patients show at least some improvement after the first three treatments. 75-99% of self-reports indicate improvement after 6-10 weeks.

Depression can take up to 3 weeks for initial response.

Insomnia varies widely with some individuals having improved sleep immediately and others not having improved sleep until 2 months into treatment. Those who benefited reported that they went to sleep faster, awoke fewer times during the night, and felt more refreshed in the morning. A longitudinal study reports enduring improvement that lasted for two years.

Dreams may become very vivid the first few weeks.

CES treatments are cumulative; however, most patients show at least some improvement after the first three treatments. 75-99% of self-reports indicate improvement after 6-10 weeks.

Depression can take up to 3 weeks for initial response.

Insomnia varies widely with some individuals having improved sleep immediately and others not having improved sleep until 2 months into treatment. Those who benefited reported that they went to sleep faster, awoke fewer times during the night, and felt more refreshed in the morning. A longitudinal study reports enduring improvement that lasted for two years.

Dreams may become very vivid the first few weeks.

What it does to your brain

A functional magnetic resonance imaging study showed that CES causes changes similar to those produced by anxiety medications. It also showed a significant reduction in the activation of the cingulate cortex, both anterior and posterior, which serves to change the connectivity within the default mode network. Electroencephalographic studies show that CES increases and slows alpha activity (increased relaxation), decreases delta activity (reduced fatigue), and decreased beta activity (decreased ruminative thoughts). Neurotransmitter studies revealed that CES increased blood plasma levels of endorphin, adrenocorticotrophic hormone, serotonin, melatonin, norepinephrine, and cholinesterase. CES also decreased serum cortisol levels and potentially blood oxygen levels, which is often elevated in chronic pain, through an increase in inhibitory neurotransmission.

There is no difference in thalamic activity when wearing the device, although 42-46% of the current can be recorded there. One theory suggests the mechanism may be via the introduction of cortical noise. The deactivation appears to depend more on frequency (100 Hz) than intensity.

Brands

Several brands of CES devices are available. We prefer two brands: CES Ultra and the David Delight Pro from Mind Alive. The CES Ultra is a stand-alone unit with one purpose – to deliver a CES session. The David Delight Pro combines CES with audio-visual entrainment sessions to promote brain states using sound and flashing lights.

Additional Reading

Feusner, J. D., Madsen, S., Moody, T. D., Bohon, C., Hembacher, E., Bookheimer, S. Y., & Bystritsky, A. (2012). Effects of cranial electrotherapy stimulation on resting state brain activity. Brain and behavior2(3), 211-220.

Lande, R. G., & Gragnani, C. (2013). Efficacy of cranial electric stimulation for the treatment of insomnia: A randomized pilot study. Complementary therapies in medicine21(1), 8-13.

Kirsch, D. L., & Gilula, M. F. (2007). CES in the Treatment of Insomnia: A Review and Meta-analysis. Practical Pain Management7(8), 30-43.

Kirsch, D. L., & Nichols, F. (2013). Cranial electrotherapy stimulation for treatment of anxiety, depression, and insomnia. Psychiatric Clinics36(1), 169-176.