Depression is also known as clinical depression and major depressive disorder (MDD). This severe medical illness affects 15 million American adults every year or about 5-8% of the adult population of the US. Women are nearly twice as likely as men to develop major depression. The severe symptoms effect how you feel, think, and handle daily activities, such as sleeping, eating, or working. For a clinical diagnosis, the symptoms must be present for at least two weeks. It is well-known that when patients first attend chemical dependency treatment centers, clinical assessment measurers show 100% MDD, but upon completion, 33% remain depressed. Some candidate genes are known to associate with risk variations (polymorphic alleles) for low dopamine function, and hypodopaminergic trait (DNA) occurs. Many articles, including “Psychology Today” featuring the work of one of us (KB) suggested that the “thrill is gone” based on an array of reward genes known to reduce dopamine function through a well- known cascade called “Brain Reward Cascade” (see figure 1). Most scientists would agree that in essence, MDD occurs especially in patients attending a chemical dependency program as a form of lack of experiencing pleasure from everyday activities (anhedonia) included as one subset of Reward Deficiency Syndrome (RDS).
Any intervention intended to alter nervous system function using energy fields such as electricity, magnetism, electromagnetic field or all the above has been defined as Neurostimulation.
Surprisingly, historical literature has described neurostimulation to treat physical maladies for over a thousand years. Its use for psychiatric disorders became popular in the past century especially for overcoming depression (anhedonia). Since the 1930’s, Electroconvulsive therapy (ECT) was recognized as an effective treatment for severe depression, catatonia, and other mental health disorders. However, due to serious adverse side effects and poor treatment outcomes, the treatment came under scrutiny in the 1970’s. Anthony Barker, from the U.K., introduced repetitive transcranial magnetic stimulation (rTMS) as a replacement for ECT in the 1980’s. Repetitive TMS is considered a non-invasive form of neurostimulation, and lower intensity non-invasive treatment known as transcranial direct current stimulation (tDCS) was being investigated in European countries. Transcranial DCS uses the same type of energy as ECT (DC Stimulation), but although it was hundreds of times weaker (2.5-4 mA vs. 600-800 mA respectively), it was found to have a significant impact on people with depression with fewer side effects. As a result, tDCS became an approved treatment for depression in Europe and is currently available to anyone without a prescription.
Over the past 20 years, a body of science has demonstrated that tDCS is a safe and effective treatment for depression. Evidence from a meta-analysis conducted in more than 20 universities and clinics globally showed no serious adverse side effects in over 1000 subjects over 33,000 treatment sessions. Despite the overwhelming evidence in the United States, the FDA has not yet approved tDCS for the treatment of depression. However, the FDA is now considering new therapies that can reduce the symptoms of anxiety and depression in patients suffering from opioid addiction.
Therapeutic neurostimulation and neuromodulation modalities are causing real excitement amongst clinicians but have not been widely considered a front-line approach in chemical dependency programs across the United States. Recent advances in quantitative electroencephalography (QEEG) brain mapping has allowed clinicians to identify and target specific brain regions that are deregulated and may lead to dysfunctional processing of information. QEEG brain mapping enables the clinician to measure the brain directly and match deregulated systems with observable behaviors. The resolution of QEEG mapping has improved so much that the results are a close match to the results obtained through Magnetic Resonance Imagining (MRI) analysis.
One important reason for the increased interest in neurostimulation is that tDCS can induce a relaxation response within a single treatment session by increasing the amount of the major inhibitory neurotransmitter, gamma-Aminobutyric acid, (GABA) that increases relaxation. This may occur by increasing the amount of GABA at the cathodal (the negatively charged electrode) stimulation point. It has also been suggested that tDCS causes global surges of sodium and calcium ions in the astrocytes which are star-shaped, specialized glial cells, that clear the spaces between the neurons of excess potassium, which the neurons release when they’re excited. The uptake and release of neurotransmitters are also regulated by astrocytes. These substances include adenosine triphosphate, or ATP, glutamate, alanine, aspartate, glutamine, and GABA. Astrocytes store and produce glycogen, a sugar necessary for the proper functioning in the hippocampus and frontal cortex of the brain and play a role in memory and learning in the hippocampus the area of the brain responsible for connectivity between feeling (limbic) and thinking (cortical) structures. In fact, resting state functional connectivity (rsFCT) whereby one region of the brain talks to another region of the brain is so important that NIDA scientists believe that any reduction of this rsFCT will induce drug seeking behavior. This effect has been shown in the literature to increase performance, learning capabilities and the acquisition of new skills. The re-organization of large-scale networks has been shown within a single session of tDCS. By acting through mechanisms other than pharmacotherapy, Neurostimulation offers hope of treatment success where medications have failed. Since neurostimulation in contrast to medication has no serious, if any, side effects, it may be seen as being better tolerated, used alone or in combination with pharmacotherapy, psychotherapy or neurofeedback.
A growing body of evidence suggests certain types of neurostimulation might modify a broad spectrum of brain functions, giving rise to speculation about its potential to improve cognition or nonspecific symptoms in healthy individuals, thereby suggesting that similar gains might be achieved in depressed patients attending a chemical dependency residential program.
The development and testing of a new treatment modality for comorbid chemical dependence, and Major Depressive Disorder
Understanding this excitement, one of us (ND), an experienced, licensed psychologist and neuroscientist practicing in South Florida, has developed and tested a new treatment modality for patients that have co-morbid chemical dependence and Major Depressive Disorder (MDD) [see figure 2].
This modality utilizes the NeuroField™ system, the first system that measures physiological responses to pulsed electromagnetic stimulation (pEMF), tDCS and transcranial alternating current (tACS) through EEG and heart rate variability (HRV). In order to help the readership to understand this analysis we have structured this article descriptive as follows:
Method: Patients entering into the program were brain mapped with QEEG and then given a neurostimulation protocol for five to seven days while they underwent a medical detoxification protocol. They were then brain mapped again and the data was analyzed to determine if depressive symptoms were reduced and to examine changes in the QEEG.
The treatment population: Briefly, a total of 86 addicted patients, 65 males, 21 females, diagnosed with primary MDD at initial intake were provided with the NeuroField neurostimulation technique (no neurofeedback) for at least five days. Patients were asked to rate the level of depression and anxiety they felt, and their quality of sleep daily. Forty-five patients who also underwent detoxification procedures without neurostimulation (but did have neurofeedback) served as controls.
Results: The outcome shows significant changes in the QEEG of the 86 treated group as compared to the 45 controls who also underwent detoxification procedures without neurostimulation. Patients reported a significant reduction in symptoms of depression and improvement in sleep by day five of the detox procedure. No adverse side effects were noted by medical staff, and the treatment was tolerated well by all participants. Symptom ratings for depression and insomnia decreased significantly from the start of therapy until day five of the study. Significant changes in the stimulation group were observed in the delta, theta, alpha, beta, high beta and gamma frequency bands. The no stimulation control group had significant changes in the alpha frequency band only (see figures 3 -5 at right).
On the other hand, Figures 6 and 7 (at right) represent the significant findings with neurostimulation group only. In figure 6, notice the brain map showing a reduction in delta frequency in post –treatment which is highlighted in figure 7 represented as an analytic graph. Also, notice that similar to the neurofeedback control group, alpha frequency was reduced as expected for benefiting a depressed patient (Figure 8 at right).
Both groups were given detoxification medications which indicate that the stimulation group’s pre vs. post differences were associated with more than a medication effect. The literature suggests that elevated frontal alpha is associated with major depressive symptoms. It is also known that depression is also linked to high delta waves as well. Both groups showed a reduction in frontal alpha that was significant. However, the stimulation only group also showed reductions across the frequency spectrum (0.5-50 Hz range) especially for both alpha ad delta frequencies which suggests that neurostimulation paired with medical intervention may have enhanced the outcome. The importance here is that
neurostimulation caused more significant changes than the neurofeedback group in a faster amount of time than is normally observed in neurofeedback studies. This in by itself has potential therapeutic implications highlighting the real importance of neurostimulation in these depressed patients.
In summary, unlike other neurostimulation paradigms, the selected adopted novel Neurofield technology utilizing very low intensity showed not only therapeutic advantage in these recovering depressed patients but provided a clear depiction of the Mechanism of Action (MOA) as measured by QEEG. More research is needed in this area to determine the long-term impact of neurostimulation on addiction and MDD. However, these first study outcomes as reported herein are compelling. Most significant is that our study patients are excited about their progress especially about “redeeming joy”!
Figure 3. QEEG Brain Maps for Controls
Figure 4. Graphic analysis showing reduction of Alpha in controls
Figure 5. Graphic analysis showing no change in Delta in controls
Figure 6. Stimulation Only Group
Figure 7 –Graphic representation showing reduction in delta frequency post neurostimulation treatment.
Figure 8 –Illustrating that post-neurostimulation treatment Alpha frequency is reduced similar to the neurofeedback control.
Dr. Dogris is a licensed health Psychologist and Neuroscientist who practices in Santa Barbara, CA. Dr. Dogris is the Neurorehabilitation Director at the Florida House Experience in Deerfield Beach, FL. He is an expert in the field of psychology with board certifications in neurofeedback and quantitative electroencephalography (QEEG) analysis. Dr. Dogris developed the first, synchronized, neuromodulation and neurostimulation system that utilized normed referenced data and QEEG analysis for the treatment of multiple neurological problems.
Kenneth Blum, B.Sc. (Pharmacy), M.Sc., Ph.D. & DHL; received his Ph.D. in Neuropharmacology from New York Medical Collegeand graduated from Columbia University and New Jersey College of Medicine. He has published more than 550 abstracts; peerreviewed articles and 14-books.