CES in the Treatment of Depression

Part 1 of this two-part series reviews diagnoses, treatment modalities, and compares CES efficacy with that of the most popular pharmaceutical treatments for depression.

 By Daniel L. Kirsch, PhD, DAAPM, FAIS and Marshall F. Gilula, MD

According to NIH findings, one in 20 American adults experience major depression in a given year.¹ The Depression and Bipolar Support Alliance report that 16 million people suffer from depression annually, with twice as many women afflicted as men. They estimate that as many as 25% of women suffer from depression serious enough to require treatment at least once in their lifetime.²The National Alliance on Mental Illness indicates that “major depression is the leading cause of disability in the United States and many other developed countries, and affects 15 million American adults or about 5 to 8% of the adult population in a given year.”³

Many other comorbid disabilities—such as cardiovascular events—can accompany depression. Depression may also result in chronically elevated levels of stress hormones, such as cortisol and epinephrine, and thus represents a condition that diverts metabolism away from tissue repair when needed for healing. Feelings of helplessness or of being out of control of one’s life also impair the immune system, increasing susceptibility to a wide spectrum of pathologies from infections to cancer. The fact that women are twice as likely as men to develop depression is also in accord with the finding that, in U.S. society, it is more likely for women to feel out of control of their lives.⁴

Aside from the general population, chronic pain patients almost invariable suffer depression as a direct result of their pain and accompanying disability. Almost any chronic illness, especially ones with no clearly effective treatment, have a high incidence of comorbid depression. Based on these descriptions of the physical manifestations of depression, it is clear that it can have a devastating effect in the pain patient and others with chronic diseases.

While depression is a common term for describing how one feels, the technical psychiatric definition goes beyond just a feeling of sadness. For such a commonly-used term, it behooves us to scrutinize some technical definitions and terms. Depression is a “mental state characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs include psychomotor retardation or, at times, agitation, withdrawal from interpersonal contact, and vegetative symptoms such as insomnia and anorexia. The term refers to either a mood that is so characterized or a mood disorder.”⁵

Definitions

Mood disorder is now the preferred term in both the World Health Organization’s (WHO) 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the American Psychiatric Association’s (APA) fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Official mood disorder categories in current use include bipolar disorders (with manic or hypomanic, depressive, or mixed episodes) and major depressive disorders and their respective attenuated variants known as cyclothymic and dysthymic disorders.⁶ Many of the older terms such as “atypical depression,” “endogenous depression,” and “involutional melancholia” are included within major depressive disorders. The older “depressive neurosis” has been replaced and absorbed by dysthymic disorder.

Table 1 summarizes the DSM-IV diagnoses that involve depression.⁷ The specific psychiatric criteria for a Major Depressive Disorder, listed on pages 168-9 of the DSM-IV-TR, require that “five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning. At least one of the symptoms is either depressed mood or loss of interest or pleasure and the symptoms are not obviously secondary to a general medical condition or “mood-incongruent delusions or hallucinations.” The symptoms are:

1. . Depressed mood most of the day, nearly daily, and/or irritable mood in children and adolescents.
2. Markedly diminished interest or pleasure in most activities.
3. Significant weight loss when not dieting—or weight gain.
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation.
6. Fatigue or loss of energy.
7. Feelings of worthlessness or excessive or inappropriate guilt.
8. Diminished ability to think or concentrate, or indecisiveness.
9. Recurrent thoughts of death beyond a fear of dying, recurrent suicidal ideation, or a suicide attempt or specific plan.

Treatment Protocols

The National Institutes of Health (NIH) describes depression as a serious medical condition that affects thoughts, feelings, and the ability to function.¹ Depression is labeled a treatable disorder of the brain, with 80% of patients responding to treatment. The NIH, as well as other researchers, declare depression to be mainly a biochemical problem and, therefore, the first line of treatment should be psychopharmaceutical intervention, possibly accompanied by psychotherapy, counseling, exercise, or other wellness techniques. In the following sections, we will focus on three basic modalities in the treatment of depression: psychoanalysis-related, pharmaceutical, and micro-current cranial electrotherapy stimulation

 click here to continue reading pages 2-4 

Electromedicine: CES in the Treatment of Depression, Part 2

 By Daniel L. Kirsch, PhD, DAAPM, FAIS and Marshall F. Gilula, MD

Daniel L. Kirsch, PhD; Marshall F. Gilula, MD

Cranial electrotherapy stimulation (CES) is the FDA recognized generic category for medical devices using microcurrent levels of electrical stimulation applied across the head via transcutaneous electrodes for the treatment of anxiety, insomnia and depression. CES treats depression by passing tiny electrical currents—similar to those found naturally in the body—imperceptibly through the brain. The microcurrent, delivered in a unique waveform, moves electrons through the brain at a variety of frequencies collectively known as harmonic resonance. This normalizes the electrical activity of the brain as measured by an electroencephalogram (EEG). The patient undergoing CES treatment will often report a pleasant, relaxed feeling of well-being. Improvement is usually experienced during treatment, but may be seen hours later, or even the day after treatment. Depression control is often experienced after two to three weeks of daily treatment. Ear clip electrodes, moistened with an appropriate conducting solution, are applied for 20 minutes to an hour or more on an initial daily basis for 3-6 weeks, followed by a reduced schedule of 2 or 3 treatments a week until the depression is resolved, and then further reduced to an as-needed (p.r.n.) basis.

This article focuses on the meta-analysis of CES studies of depression along with a discussion of individual study designs and outcomes. It is important to note that protocols for some CES studies were poorly designed; inconsistent patient selection and concurrent use of other pharmaceutical modalities rendered the results inconclusive with regard to CES efficacy in treating depression. The authors have carefully selected only valid studies to provide the most complete and accurate meta-analysis of CES depression treatment outcomes.

Early CES Studies In Treating Depression
Rosenthal conducted some of the earliest CES studies of depression when CES was first introduced in the U.S. His work was primarily with psychiatric outpatients, although he sometimes used medical staff as controls. He was basically trying to find out what, if anything, CES treatment would do for his patients, how many sessions it might require, and what level of current it took to get results.^1-4

Please refer to the June 2007 issue for the complete text. In the event you need to order a back issue, please click here.

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