Anxiety Can Be Treated With Cranial Electrical Stimulation Therapy, Evidence Review Finds

A clinical evidence assessment by ECRI, a global patient safety organization, found that cranial electrical stimulation relieves anxiety symptoms. The treatment was found to be more effective at relieving symptoms than fake stimulation—with or without medication—for some patients.

Cranial electrical stimulation (CES) is a noninvasive neuromodulation technique intended to treat some psychiatric disorders, including anxiety disorders, by delivering diffuse electrical stimulation through electrodes placed on the patient's scalp or earlobes. This type of electrical stimulation is thought to normalize electrical activity in parts of the brain that contribute to excessive fear and anxiety.

Evidence suggests some effects of CES persist for at least one month after treatment stops, and in some cases, may continue for up to six months. It is unclear if patients continue to respond to the treatment over longer periods of time.

CES is not to be confused with electroconvulsive therapy, a different, more invasive treatment that is considered a last resort therapy for treatment-resistant depression and other psychiatric pathologies.

Treatment for anxiety disorders usually involves medication, psychotherapy, or both. However, these treatments do not work for all patients. Psychotherapy may be expensive, and it may be difficult to find a suitable psychotherapist. Some patients experience negative side effects from medication or do not want to take daily medication. Two cost studies suggested that cranial electrical stimulation may provide a cheaper alternative for patients seeking treatment.

"Cranial electrical stimulation is not widely used to treat anxiety," said Marcus Schabacker, MD, PhD, President and CEO at ECRI. "Most patients bear the full cost of treatment since it's not covered by Medicare, Medicaid, or most private payer insurance companies. Usually, patients who have had this treatment have done it in a research setting, or they've exhausted all other options for treatment with no success. Because this treatment can be given by a nurse in a clinic, or by the patient at home, it could be more convenient than psychotherapy, and it's scalable. It can be given with little-to-no psychiatry time."

ECRI assessed peer-reviewed clinical literature published through mid-April of 2024 that addressed the treatment's safety and effectiveness for anxiety, including five studies of more than 630 patients.

"This therapy has been studied since the 60's, but until now there hasn't been sufficient evidence showing that it's a successful treatment option," added Schabacker. "But new research in the last several years sheds light on this treatment option as a way to relieve anxiety symptoms—not necessarily to replace the traditional treatment pathways of psychotherapy and medication. It's exciting to see we now have a body of work that presents evidence of its effectiveness.

Anxiety disorders are among the most common psychiatric illnesses. Anxiety disorders include generalized anxiety disorder, panic disorder, phobias, social anxiety disorder, separation anxiety disorder, and selective mutism (i.e., the inability to speak in certain situations).

ECRI also assessed cranial electrical stimulation's safety and effectiveness for treating depression and insomnia. However, the published evidence is insufficient to determine whether it improves symptoms for patients with depression or insomnia.

The ECRI team that generated this clinical evidence assessment helps healthcare providers, third-party payers, and industry leaders make objective, evidence-based decisions on new, emerging, and existing healthcare products and interventions. These doctoral-level researchers identify, synthesize, and rate the strength and quality of the available evidence to help to drive positive outcomes, improve care quality, and lower costs.

About ECRI:

ECRI is the world’s only healthcare organization with the unique combination of capabilities including device evaluation in an independent testing lab; clinical safety expertise through the ECRI Patient Safety Office (PSO); alerts that track safety problems with medical devices long before they escalate to an FDA safety bulletin; and supply chain guidance for identifying functional equivalents in the marketplace.

For more information:

Contact Yvonne Rhodes, Associate Director of Strategic Communications, at YRhodes@ECRI.org.