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Exploring the relationship between anxiety and depression
Exploring the relationship between anxiety and depression

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6 ‘Electrotherapy’ for anxiety and depression?

There has been some interest in recent years in ‘electrotherapy’ (cranial electrotherapy stimulation) for the treatment of mood disorders (this is not to be confused with electroconvulsive therapy or ‘ECT’, sometimes also referred to as ‘electroshock therapy’, which has long been recognised as effective for treatment-resistant depression). Interest in this potential new therapy centres around a portable device, the Alpha-Stim SCS, which sends mild (50-100 microamp) electrical currents through the body by way of wires attached to the earlobes, and is thought to modulate brain activity ‘at rest’ inducing a ‘relaxed, yet alert’ state. The device’s American inventor, Dr Daniel Kirsch has authored papers (Kirsch et al., 2014; Kirsch and Nichols, 2013) reporting on benefits of the use of the device for wide-ranging conditions from fibromyalgia through to anxiety, PTSD and insomnia. Patrick Strudwick, reporting for the Telegraph in 2010, wrote about his experience of using this new device (Strudwick, 2010).

Used by the military:

The Alpha-Stim device has been used by the US military for the treatment of anxiety, PTSD insomnia and depression amongst service members and veterans (Kirsch et al., 2014), and was trialled in the UK at the British Armed Forces Rehabilitation Centre in Surrey (at Headley Court), following its endorsement by Dr Bob Lister of London Metropolitan University (Strudwick, 2010). Dr Kirsch has explained that 'one of the reasons the military like this product is that many of the psychopharmacological approaches to anxiety have side effects that impair alertness' (cited in Strudwick, 2010).

Trialled within an NHS setting:

In 2016, Sayid and Jarvis, reporting for the Mirror, noted that in addition to its use for PTSD by the US and UK military, the device was also being considered in a trial carried out by Nottinghamshire Healthcare Trust, on the back of a pilot study of 12 participants which reported that 'the device reduced anxiety by 50%'. They also noted that 'if the pilot gets the go-ahead from the National Institute for Health and Care Excellence it could be rolled out by the NHS within two years' (Sayid and Jarvis, 2016).

The UK’s National Institute for Health Research (NIHR) issued a news release on 22 June 2017 titled ‘East Midlands leads commercial study to help treatment of anxiety with a device’, which referred to evaluation of the Alpha-Stim device ‘in the treatment of moderate to high anxiety’. The release noted that 'Nottinghamshire Healthcare NHS Foundation Trust was chosen by the commercial sponsors as the single site for running the study… All participants were suffering from moderate to high anxiety and were on the waiting list in Leicestershire and Rutland "Let’s Talk Wellbeing" Improving Access to Psychological Therapies services for Step 3 intensive psychological therapy' (NIHR, 2017).

The Health Research Authority’s website ‘Clinical and cost effectiveness of Alpha-Stim AID CES [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] ' described this commercially-sponsored study as 'a naturalistic study in patients with a primary working diagnosis of moderate-to-severe generalised anxiety disorder who did not improve with low intensity psychological therapy', specifying that this is 'a single-centre research study in patients seen within an NHS Improving Access to Psychological Interventions (IAPT) service with suspected generalised anxiety disorder (GAD)'. The study involves '120 patients from the Leicestershire and Rutland area' who will use the device 'for 60 minutes every day for 6 or 12 weeks, either whilst on the waiting list for standard care treatment from IAPT, or in conjunction with standard care treatment from IAPT'. The website also explains that 'The study will involve 6 study visits − one face-to-face at visit 1, followed by 5 visits via telephone at week 4, 6, 8, 12 and 24. At each visit, participants will be asked to complete questionnaires to assess anxiety, depression, sleep difficulty, quality of life and work and social functioning. The purpose of the study is to gather evidence for the clinical benefits and cost effectiveness of the Alpha-Stim AID when used in an NHS setting − how well does it work, and does its use result in cost savings for the NHS. The study may show that the Alpha-Stim AID should be available on the NHS for patients with suspected GAD.' The follow-up was expected to continue up until September 2017, after which the results are expected to be published (NIHR, 2017).

You can read the latest published results in Morriss et al. (2019) in the Journal of Affective Disorders. Two further press releases were issued by the company behind the product (Alpha-Stim 2019a and 2019b) with The Sunday Times stating that 'half of patients went into remission after treating themselves with the battery-operated device' and that 'researchers say it has the potential to revolutionise mental healthcare and could save the health service millions of pounds' (Gregory 2019).

Offered to teachers:

David Jarvis, reporting for the Telegraph (2017), has separately flagged the use of the device as a ‘drug-free treatment’ that is being rolled out to teachers at seven primary, seven secondary and a special educational needs school in Kent. The decision was taken by Leigh Academies Trust after a pilot scheme 'to combat anxiety and depression' and to 'help teachers cope with what is recognised as a nationwide problem', 'augmenting existing strategies to deal with stress'. Other than its non-invasive nature and its potential to offer an alternative form of therapy to medication, part of the appeal of the device may also be in its appearance, which is non-intrusive, hands-free and 'gives the impression the patient is simply wearing headphones'. The article raises the issue that workload and stress among teachers ranks in the top three most stressful occupations (recall your reading from Exploring anxiety, and the report from the Health and Safety Executive). The pilot, which involved 21 staff using the device for between 20 and 60 minutes over a period of four weeks, found that 'participants had better post-treatment sleep quality'.