Depression is a primary cause of disability globally, according to the World Health Organization, which tallies more than 300 million people suffering from depression worldwide. For a person with clinical depression, the search for an effective pharmaceutical solution often involves a long and frustrating series of trial-and-error experiments. It takes six weeks or more for the effects of antidepressant medications to kick in sufficiently for patients and their physicians to assess the benefits. Months and years of hoping that various drugs can help, despite frequent and unpleasant side effects, are depressing even without the initial complaint; that’s why we are bullish on non-pharmaceutical treatments for depression.
We wrote about a helmet that uses magnetism and the use of online feedback to reduce depression therapy deterioration. We’ve also written about several products that use neurostimulation to control or at least temper depression’s emotional suffering. Most recently, last December, we covered Flow, a medication-free headset and smartphone app developed by Flow Neuroscience to treats depression with transcranial Direct Current Stimulation. (tDCS). As of the end of 2018, the system was scheduled to launch in Europe in early 2019 while pursuing clearance from the FDA in the U.S.
As of June 4, 2019, Flow launched in the U.K. for consumer purchase and use at home. According to the company launch release, Flow Neuroscience has begun efforts with the UK National Health Service (NHS) to have Flow approved for medical prescription.
In support of its science and the use of neurostimulation to treat depression, Flow Neuroscience cites two studies of the treatment technology (not the product) in its press release announcing the June 4 launch. One study was published in The New England Journal of Medicine in 2017 and the other in The British Journal of Psychiatry in 2016. Unexpectedly, while the NEJM study did show tDCS was superior to a placebo in treating unipolar depression, it does not show tDCS is not inferior to the drug escitalopram, a selective serotonin re-uptake inhibitor. What that means is the neurostim results were substantially worse than the medication.
The earlier British study concluded that the effect of tDCS was comparable to repetitive transcranial magnetic stimulation and antidepressant drug treatment. The study with more positive results also stated that future trials should study differences with tDCS applications based on depression refractoriness (treatment resistance) and tDCS dose. tDCS was more effective with two groups of patients: those with higher levels of treatment resistance and those given higher tDCS doses.
In the end, we can’t say that Flow or any tDCS application or device is a new gold standard for treating depression. What the studies do show, however, is that tDCS appears to be yet another tool in the medical kit that may help some patients with depression. Given the inexact science and results from standard pharmaceutical treatments for depression, plus the adverse side effects and long-duration trials, we are encouraged that some patients may find relief without drugs. Hopefully, future studies will hone neurostim science to an even more precise treatment.
