Non-drug treatment for Anxiety, Depression, and Pain
I recently sat down with my Colleague Dr. Kimberly Iller on The One Thing Podcast and we had a discussion about non-drug treatments for anxiety, pain, post-traumatic stress disorder (ptsd), and depression. Dr. Iller is an outstanding Functional Medicine Practitioner/Naturopathic Physician in the Seattle area at Functional Medicine Northwest and also the director of a non-profit clinic called Equity in Health She shared her insights and experience using Cranial Electrical Stimulation Therapy (CES) with her patients. She uses CES extensively in her practice.
What is Cranioelectrical Stimulation:
CES is an "electroceutical" technique that involves applying a pulsed, low-amplitude electrical current to the head using electrodes placed on the earlobes. Its FDA approved for the treatment of anxiety, depression, and insomnia. Also being used for fibromyalgia, chronic pain, opiate withdrawal, and headaches. There other terms used to describe this technique including transcranial electrotherapy (TCET) and neuroelectric therapy (NET). The device looks similar to Transcutaneous electrical nerve stimulation (TENS) but is configured differently.
The History of CES:
Drs. Leduc and Rouxeau of France were the first to experiment with low intensity electrical stimulation of the brain in 1902 (Appel, 1972). Initially, this method was called electrosleep as brain stimulation was considered a sleep inducer.
How does it work?
CES might influence brain activity via a pathway involving cranial nerves. Vagus nerve stimulation can lead to activation of the brain and symptomatically improve depressed patients. The CES via earlobe stimulation might influence the activity of the afferent branches of the facial, glossopharyngeal, and/or Vagus nerves.
It is proposed that some of these branches reach the ventral posteromedial nucleus of the thalamus. The thalamus is a region of the brain that seems to be important in the pathophysiology of Anxiety. Also, other disorders like Obsessive Compulsive Disorder, Post-traumatic stress disorder, and social-anxiety disorder are linked to decreases in thalamic activity.
Other researchers describe that CES works on the primitive brain at the level of the limbic system, the reticular activating system (RAS) and/or the hypothalamus.
Research by Ferdjallah, Bostick,and Barr (1996) has shown one milliampere of current applied to the head will result in about 5 microamperes/cm2 of CES reaching the thalamic area.
What is the treatment dose and duration ?
Research by Ferdjallah, Bostick,and Barr (1996) has shown one milliampere of current applied to the head will result in about 5 microamperes/cm2 of CES reaching the thalamic area.
Standard protocol for CES treatment for FDA approved conditions is use 20 minutes to one hour a day for the first three weeks, at a comfortable level of current. The treatment time may be increased as the current level is lowered. This is generally followed by treatments every other day or on an as needed basis for as long as necessary.
Treatment effects:
Following CES treatment, most patients feel less anxious, less distressed, and more focused on mental tasks. Patients with positive outcomes generally sleep better and report improved concentration, increased learning abilities, enhanced recall, and a heightened state of well-being after one or a series of CES treatments
Side effects that I have seen in practice are dizziness and headaches.
Cost:
I am most familiar with the CES units called Alpha-Stim however there is another by Fisher Wallace. You can rent the Alpha-stim units for about $100 per month.Or purchase them for about $600. I have one that you can rent out at my clinic for $5 per day if you are interested in trying , please get in touch. I know that these companies usually offer a 30-day money back guaranteed program.
In conclusion:
I really appreciate being able to offer CES treatment to patients as I find it works in most people and it’s not a pill. I am really interested in using it with IBS patients and IBD patients while in a flare and also to prevent stress from getting to danger level. I like the Linehan model of stress management. (picture courtesy of https://www.nowmattersnow.org/ )
I think anything to tone up the Vagus nerve will would likely helpful for "Fire Prevention".
Sources:
(Bystritsky, Kerwin, & Feusner, 2008; Gilula & Kirsch, 2005)Bystritsky, A., Kerwin, L., & Feusner, J. (2008). A pilot study of cranial electrotherapy stimulation for generalized anxiety disorder. Journal of Clinical Psychiatry, 69(3), 412–417. https://doi.org/10.4088/JCP.v69n0311
Gilula, M. F., & Kirsch, D. L. (2005). Investigations in Neuromodulation , Neurofeedback and Applied Neuroscience Cranial Electrotherapy Stimulation Review : A Safer Alternative to Psychopharmaceuticals in the Treatment of Depression Cranial Electrotherapy Stimulation Review : A Safer Alternat. Journal of Neurotherapy, 9(August 2013), 37–41. https://doi.org/10.1300/J184v09n02
