Cranial Electrotherapy Stimulation (CES) is the FDA name for devices which send micro currents of electricity across patient’s cranium. FDA has cleared the CES devices for treatment of anxiety, depression, and insomnia. They CES devices are considered Class III devices and they are available by prescription only. The current level sent across patient’s brain is typically limited to under 1.5mA which is several orders of magnitude lower than currents used in treatments like ECT.
The history of CES dates back to 1950s in the Soviet Union, where the Russians were investigating the effects of micro-current stimulation on the ability to promote sleep. This was done during the space program, where the astronauts were exhibiting anxiety and insomnia during the pioneering days of space exploration.
In the United States, the first device achieving FDA approval in 1978 was called Neurotone 101. Since then, over hundred of clinical trials were conducted demonstrating the safety and efficacy of CES for treatment of anxiety, depression, and insomnia.
Over the last few decades, Cranial Electrotherapy Stimulators have been extensively studied for treatment of variety of disorders. The following table summaries a meta-analysis of number of clinical trials for each disorder*:
Number of Studies
Number of Subjects
*Source: Ray B. Smith, Ph.D. Cranial Electrotherapy Stimulation, 17, 2007.
The paper by Barclay TH, Barclay RD. A clinical trial of cranial electrotherapy stimulation for anxiety and comorbid depression, Journal of Affective Disorders, 164:171-177, 2014, presented at the American Psychological Association National Conference, Honolulu, HI, July 2013, represents one of the recent clinical trials with a reasonable large sample size (N=115) for patients exhibiting anxiety with comorbid depression. The authors concluded that, “CES significantly decreases anxiety and comorbid depression. Subjects reported no adverse events during the study.“
A meta analysis of the “18 most carefully conducted randomized controlled trials of CES vs sham” revealed that, “CES to be significantly more effective than sham treatment (p<0.05).” Please see the abstract of the study here: Meta-analysis of randomized controlled trials of cranial electrostimulation. Efficacy in treating selected psychological and physiological conditions.
DeFelice (1997) conducted a meta analysis of 34 controlled clinical trials concerning the efficacy of CES in the treatment of anxiety and other stress‐related disorders were evaluated. The author states, “Overall the results suggest that CES may be capable of producing significant (p<0.05) benefit in the short‐term symptomatic relief of anxiety and other stress‐related disorders. CES may be effective alone and as an adjunct to other conservative measures of treatment. The primary mechanism of action of CES appears to be a direct effect on the brain followed by secondary responses.”
Cervella is the first CES device specifically developed for active-lifestyle patients who suffer from anxiety, depression, and insomnia disorders. Through patient research, we have found that many anxiety sufferers, as well as depression patients, are usually very self-conscious about their disorder. Cervella offers discreet features that allow patients to administer a treatment session at school, at work or even around town as needed. It also features Bluetooth sound integration with high quality stereo headphones, which adds to the great value and functionality of the device. The affordable price point keeps Cervella within reach of many patients despite the lack of medical reimbursment with many insurance providers.
Because of the inconspicuous appearance of the Cervella device, patients are more apt to use Cervella outside of the comfort of their homes increasing the compliance and use of the device during stressful events. Furthermore, Cervella is the first and only CES device that is managed through an App on a smart device.
This feature allows for automated treatment data recording, treatment reminders, and cloud integration. It also gives the patient an option to easily share treatment data with his or her health provider in order to better manage the treatment plan.
According to clinical studies, there are several mechanisms of actions for the Cranial Electrotherapy Stimulator. One of the mechanisms is changes in cortical brain activity, including effects on the DMN (Default Mode Network). According to, Feusner (2012) study, “Results suggest that CES causes cortical brain deactivation, with a similar pattern for high- and low-frequency stimulation, and alters connectivity in the DMN.”
Additional studies by Kennerly (2004) suggest that the CES stimulation affects the endogenous brain oscillations (specifically increase in alpha activity and decrease in delta activity).
Liss (1996) postulates that the CES affects the levels of neurotransmitter levels in the CSF, specifically serototnin and beta-endorphin which may also contribute to reduction of patient’s depressive mood and increase of the sense of well-being.
The following is a partial list of clinical trials and research on the efficacy of Cranial Electrotherapy Stimulation. Note that, as per the FDA requirement, Cervella is substantially equivalent in the underlying principle of operation (current intensity levels, frequencies, treatment duration) to the CES devices cited in the various clinical trials.
Please see the set-up and operation video for the Cervella Cranial Electrotherapy Stimulator below: