Effectiveness of Cranial Electrical Stimulation Compared to Antidepressants for Depression and Anxiety
Cranial electrical stimulation (CES) has insufficient evidence to recommend it over antidepressants for treating depression and anxiety, with most studies showing conflicting or inconclusive results compared to the well-established efficacy of antidepressant medications.
Evidence on CES for Depression and Anxiety
Current evidence for CES in treating depression and anxiety is limited and of low quality, with most trials having small sample sizes, short durations, and high risk of bias due to inadequate blinding 1.
A systematic review found insufficient evidence that CES has clinically important effects on depression, with only low-strength evidence suggesting modest benefit in patients with anxiety and depression 1.
One study examining CES as an add-on intervention for treatment-resistant major depressive disorder found no significant difference between active CES and sham treatment, suggesting potential placebo effects 2.
In a study with healthy postmenopausal women, 8 weeks of CES treatment showed significantly decreased Tension-Anxiety and Depression-Dejection scores compared to pre-treatment scores, but did not induce changes in blood levels of neurotrophic factors or HPA-axis-related hormones 3.
Evidence on Antidepressants for Depression and Anxiety
Second-generation antidepressants (including SSRIs, SNRIs, and others) have established efficacy for treating depression, with approximately 62% of patients achieving treatment response and 46% achieving remission during 6-12 weeks of treatment 4.
For anxiety symptoms accompanying depression, multiple fair-quality head-to-head trials have shown similar efficacy among various antidepressants, including fluoxetine, paroxetine, sertraline, bupropion, and venlafaxine 4.
While different antidepressants show similar overall efficacy, they may differ in onset of action, with mirtazapine showing a statistically significantly faster onset compared to citalopram, fluoxetine, paroxetine, or sertraline 4.
Safety Considerations
CES appears to have a favorable safety profile with rare adverse effects (<1%), which are typically mild and self-limiting, consisting mainly of skin irritation under the electrodes and headaches 5.
Low-strength evidence suggests that CES does not cause serious side effects 1.
In contrast, antidepressants are associated with various side effects including nausea, diarrhea, headache, tremor, daytime sedation, decreased libido, failure to achieve orgasm, nervousness, and insomnia 4.
Potential Applications of CES
CES may be considered as an adjunctive therapy rather than a stand-alone treatment for depression and anxiety 5.
One prospective observational cohort study found that CES was clinically effective on both anxiety and depression symptoms in patients with generalized anxiety disorder (GAD), with sustained remission at 12 and 24 weeks 6.
For optimal effectiveness, this study suggested that CES response to anxiety symptoms in the first 4 weeks and improvement in depression symptoms by 12 weeks were important 6.
Limitations of Current Evidence
Most CES trials have methodological limitations including small sample sizes, short durations, and high risk of bias due to inadequate blinding 1.
The mechanism of action for CES remains unclear, with studies showing conflicting results regarding its effects on neurotrophic factors and HPA-axis regulation 3.
Different CES devices, parameters, and treatment protocols make it difficult to draw definitive conclusions about overall efficacy 2.
Clinical Recommendation
Based on current evidence, antidepressants remain the first-line pharmacological treatment for depression and anxiety due to their established efficacy and well-understood risk-benefit profile 4.
For patients who cannot tolerate antidepressants or prefer non-pharmacological options, CES might be considered as an adjunctive therapy, but patients should be informed about the limited and conflicting evidence regarding its efficacy 5, 1.
When considering CES, treatment should be monitored closely for response, with particular attention to anxiety symptoms in the first 4 weeks and depression symptoms by 12 weeks 6.