Cranial electrical stimulation has modest benefit in combined anxiety, depression

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Takeaway

  • Review suggests that cranial electrical stimulation (CES) benefits patients with anxiety plus depression, but not either alone.
  • CES had no apparent effect on fibromyalgia, headache, neuromusculoskeletal pain, degenerative joint pain, depression, or insomnia.
  • Commonly used CES devices in the United States include Alpha-Stim products and the Fisher Wallace Stimulator.

Why this matters

  • Physicians may receive requests for CES device prescriptions, or patients may have purchased them from online auction sites or overseas manufacturers.

Key results

  • CES showed greater improvement from baseline to week 5 in patients having anxiety and depression (1 study; n=108):
    • Hamilton Depression Rating Scale scores: standardized mean difference (SMD), −0.78 (95% CI, −1.18 to −0.39);
    • Hamilton Anxiety Rating Scale scores: SMD, −0.94 (95% CI, −1.34 to −0.54).
  • Inconclusive/unclear evidence for CES in chronic painful conditions, depression, anxiety, and insomnia.
  • 1 study showed worsening of depression (n=4) and hospitalization (n=2) with CES machine (Electrosone-50; no longer in use).

Study design

  • Systematic review, 26 randomized controlled studies.
  • Funding: Veterans Affairs Quality Enhancement Research Initiative.

Limitations

  • The evidence for these methods is weak and often relies on decades-old studies; in some cases, the studies used devices that are no longer available.

Couthored with Chitra Ravi, MPharm