Then I picked up a year-old copy of my favorite practical evidence-based psychiatry newsletter, The Carlat Report. A college asked me, “Why don’t we try one of those machines they talk about in this article?” The machines discussed were the Alpha-Stim, one of several CES devices on the market. The psychiatrist interviewed in The Carlat Report said they could be quite useful, and in her opinion, worked well for folks with anxiety and insomnia, often enabling patients who relied heavily on addictive benzodiazepines or sleeping medications to reduce or eliminate those medicines. The machines are FDA cleared for the treatment of anxiety, insomnia, depression, and some pain syndromes.
Well, that sounded quite promising. In a psychiatry clinic like ours, we have a host of patients with anxiety and/or insomnia who have not been fully helped by non-addictive meds and therapy, who thus rely on benzodiazepines and sleeping meds every day. Often patients come in for the first time already on these meds, and we work for months to years to reduce or eliminate them if possible. It would be great to have an easier and effective way to decrease the use of addictive and sleeping medications. Other patients who don’t want to use those meds struggle with constant anxiety they’ve lived with for years. But could a machine that looks a bit like an old mp3 player with electrodes you clamp to your earlobes really help?
So I decided, finally, to look into the available literature. We also bit the bullet and purchased one of the machines for about $800.
I promptly discovered we are quite late to the party. CES was invented in the Soviet Union in 1954 (I am picturing some Jason Bourne-type superhuman-creating experiments to improve Soviet athletes or chess players), spread rapidly through the Eastern Bloc, Europe, and Japan and arrived in the US in the 60s. University research started with treating insomnia and pain syndromes. In 1979, Dr. Daniel Kirsch invented the particular waveform used in the Alpha-Stim, which is based on a waveform put out by healthy nerve tissue. This device has since been used in over 100 independent and many peer-reviewed studies* for anxiety, depression, insomnia, and pain. It is widely used and studied in the army, particularly in PTSD, and the VA will pay for the devices for veterans. Dentists use CES machines for acute anxiety regulation for their patients, and psychiatrists, psychologists, and physical therapists in Texas and the South apparently know all about the machine and have a lot of experience with it.
But what does the machine do, and how does it work? An fMRI study shows it decreases cortical activity, and cerebral spinal fluid studies show it increases serotonin and beta endorphins in the central nervous system. Quantitative EEG reports show it decreases (deep sleep) delta waves and increases alpha waves, associated with meditation and first stage sleep…thus, acutely, the application of the micro current can lead to a sense of alert but calm energy, clearheadedness, and wellbeing. Sessions last from 20-60 minutes depending on the amount of current you can tolerate. Side effects can include vertigo or dizziness (if the stimulation is set too high or you can’t tolerate the machine), headache (approx 1 in 1000) or skin irritation (approx 1 in 1500). No cases of mania or serotonin syndrome have been reported.
Long term, daily or near daily use of the machine for 3-6 weeks can be quite effective in improving sleep, anxiety, and depression symptoms, according to several randomized controlled trials. This effect can be maintained with 2-3X a week treatments. It doesn’t work for everyone, and a pilot trial in Alzheimer’s patients was negative. Anecdotal experience from colleagues who use the device supports the anxiety and insomnia research.
My own n=1 experience showed an immediate decrease in feelings of stress for 6-7 hours (that feels a little too good to be quite legal…a bit like the “high” after a good workout) with early morning treatment, followed by a solid and restorative night’s sleep. You can see the improvement in my sleep tracking software: the first image is from a typical night in the week before using the machine. The second is the first night after morning use.
I did have the machine set too high the first time (my own fault), resulting in a couple hours of residual dizziness, and I did experience a very mild “crash” of sorts after about 7 hours, though that went away after the 10th daily use and hasn’t come back. My response and the feedback from the patients we had try it in clinic was positive enough that we bought two more machines. All my clinic colleagues have used it, with one other immediately buying a machine of her own, and another unable to tolerate even the lowest setting.
What are the down sides, besides cost (though repeated therapy visits and copays for meds can add up quickly)? What does even a tiny electric current applied to your brain nearly every day do to you, long term? The Facebook site has anecdotes of people using the device for 10 years or more, but there’s not really any solid long term data. However, insomnia and anxiety long term is definitely not good for the body and brain, and long term use of sleep medications is linked to dementia, so if a device can improve deep, restorative sleep and reduce anxiety without addiction, the risks and benefits discussion can tilt pretty quickly. The data for conditions such as bipolar depression or psychosis are very limited, though the machine is used in inpatient psych unites, head injury and stroke recovery units, so quite sick folks, without problems or side effects other than those mentioned above. The only contraindications are pregnancy and powered implanted medical devices such as pacemakers.
For my patients with anxiety and depression, I use a simple metaphor…usually they’ve struggled for years with symptoms we now know is related to the sympathetic “fight or flight” nervous system engaged in high gear. Meditation, therapy, sleep management, lifestyle advice…all of this is geared to powering up the parasympathetic “rest and digest” nervous system that has become atrophied under the burden of constant stress, depression, insomnia, and anxiety. These folks are like the guys at the gym who only do chest presses and biceps curls…they get jacked but walk around like bent-over gorillas. What they need are lat pulls and posterior chain exercises to equalize their bodies, and lifestyle interventions, relaxation, and restorative sleep can strengthen that weak “rest and digest” nervous system. I postulate the CES machines force the brain to work on those lat pulls, to chill out and get to a meditative state, but passively, without the hard work and practice of very effective meditation. In any event, another useful weapon in the armamentarium against chronic anxiety and insomnia is always welcome.
I’m going to continue to use the machine for now, though I doubt I’ll ever walk around all day with electrodes stuck to my forehead or inject the blood of my younger peers…